1. In mild to moderately obese patients, gastric bypass surgery plus intensive lifestyle modifications demonstrates better cardio-metabolic risk factor reduction than lifestyle modification alone in one year.
2. Patients in the gastric bypass group took fewer medications in comparison to patients in the lifestyle-medical management group.
Evidence Rating Level: 1 (Excellent)
Study Rundown: In this study, mild to moderately obese, diabetic patients study were randomized to Roux-en-Y gastric bypass surgery plus intensive lifestyle modification or intensive lifestyle modification alone. Those in the surgery group achieved significantly higher success rates in attaining a composite goal of diabetes management (incorporating HbA1c, LDL cholesterol, systolic blood pressure). While surgery such as gastric bypass seems to have an immediate positive effect on the reduction of comorbidity risk factors in metabolic syndrome, there must be caution as these remain surrogate markers.
Furthermore, there remain several limitations in our understanding that need to be better elucidated in moving forward. For example, the actual effect of gastric bypass on microvascular complications has not been well characterized. The economic implications of promoting gastric bypass surgery should be further evaluated as well. In addition to the cost of surgery, it should be noted that surgical and post-surgical complications remain significant. Unintended consequences secondary to malnutrition after anatomic gut alteration are examples of severe sequelae from gastric bypass surgery that should always be considered by patients and physicians. Given the findings of this study in the context of the literature, physicians should always attempt to have an open discussion with each patient to weigh the risks and benefits of gastric bypass surgery.
In Depth [randomized study]: From 2008-2011, 120 diabetic grade 2 obese participants from 4 centers in the United States and Taiwan who met the following criteria: hemoglobin A1c (HbA1c) level of 8.0% or higher, body mass index (BMI) between 30.0 and 39.9, C peptide level of more than 1.0 ng/mL, and type 2 diabetes for at least 6 months were enrolled in the study. They were randomized to Roux-en-Y gastric bypass surgery plus lifestyle-intensive medical management or medical management alone. Lifestyle-intensive modification included diet and weight reduction counseling along with medications for hyperglycemia, hypertension, and dyslipidemia according to protocol. The primary outcome was achieved if the participant met the “triple end point”: an HbA1c of less than 7.0%, an LDL cholesterol level of less than 100 mg/dL , and systolic blood pressure less than 130 mm Hg, at the 12-month visit. 11 participants (19%) in the lifestyle-medical management group and 28 (49%) in the gastric bypass group achieved the triple end point goal.
By Mike Hoaglin and Rif Rahman
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