Does Benefit of Weight-Loss Surgery for Patients with Diabetes Persist Over Time?

Bottom Line: Obese adults with type 2 diabetes who underwent gastric bypass surgery continued to improve after five years at meeting a target for blood sugar, cholesterol and blood pressure control but that improvement seemed to lessen over time.
 
Why The Research Is Interesting: Reducing vascular and cardiovascular risks related to type 2 diabetes requires blood sugar control along with control of blood pressure and cholesterol. Roux-en-Y gastric bypass surgery is effective at achieving these diabetes treatment targets but whether the effects are long-lasting is unknown. The current study reports on longer-term outcomes for participants in a randomized clinical trial after five years.
 
Who and When: 120 obese adults with type 2 diabetes (half underwent Roux-en-Y gastric bypass surgery plus lifestyle and medical management interventions, the other half received lifestyle and medical management interventions alone); five-year follow up ended in 2016.
 
Study Measures: A composite measure of diabetes control: hemoglobin A1c less than 7.0 percent, low-density lipoprotein cholesterol less than 100 mg/dL, and systolic blood pressure less than 130 mm Hg after five years.
 
How (Study Design): Five year follow-up of patients randomized to Roux-en-Y gastric bypass surgery plus lifestyle and medical management interventions or lifestyle and medical management interventions alone.
 
Authors: Charles Billington, M.D., University of Minnesota, Minneapolis, and coauthors
 
Results: Patients who underwent gastric bypass surgery along with lifestyle and medical management interventions showed continued improvement at achieving a composite measure of diabetes control after five years but with some diminished effectiveness.
 
 
Study Limitations: Participants had diabetes for an average of nine years when they entered the study so the treatment effect on patients who had diabetes for a shorter time could be different.
 
Study Conclusions: While there was better achievement of diabetes control targets after five years, the effect was diminished over time so more follow-up is needed to understand if the improvement persists.
 
Related material:
 
The following related elements from this issue of JAMA are also available on the For The Media website:
 
— Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity
 
— Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity
 
— Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality
 
— Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities
 
— Editorial: Comparing the Outcomes of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for Severe Obesity
 
— Editorial: Reimagining Obesity in 2018 – A JAMA Theme Issue on Obesity
 
For more details and to read the full study, please visit the For The Media website.
 
(doi:10.1001/jama.2017.20813)