Thursday, June 26, 2014 – 12:23
Owen Haskins – Editor in chief, Bariatric News Gastric bypass surgery improves obese diabetic patients’ physical and mental health, more than an intensive weight loss programme involving lifestyle modifications over two years, according to the results from a study presented at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago.
“Patients with obesity and Type 2 diabetes should consider these long-term results when making decisions about their weight loss treatment,” said the study’s lead investigator, Dr Donald Simonson from Brigham and Women’s Hospital, Boston.
The researchers evaluated the effects of weight loss on 38 patients’ self-reported health status for both physical and mental health, as well as the impact of their weight on their quality of life and on problem areas in managing their Type 2 diabetes.
Fifteen men and 23 women participated in the Surgery or Lifestyle with Intensive Medical Management in the Treatment of Type 2 Diabetes (SLIMM-T2D) trial. Of the 38 patients, 19 were randomly assigned to undergo gastric bypass surgery at Brigham and Women’s Hospital, and 19 patients, to a medical diabetes and weight management programme, called Why WAIT (Weight Achievement and Intensive Treatment), at the Joslin Diabetes Center in Boston.
The programme consisted of exercise, diet with meal replacements, 12 initial weekly group sessions and nine additional months of individual counselling. Follow-up evaluation ranged from 18 to 24 months.
Before treatment, patients reported high scores on the questionnaire Impact of Weight on Quality of Life, which included physical function, self-esteem, sex life, public distress and work. Up to two years after treatment, patients who underwent gastric bypass surgery had nearly twice the improvement (reduction) in the adverse effects of weight on their quality of life, which Simonson said strongly correlated with the greater amount of weight they lost.
Two years after treatment, the surgical patients lost an average of 64.4lbs vs. 11lbs in the Why WAIT group.
At 18 to 24 months after treatment, patients in the surgical group also reported a 60 percent greater reduction in problems with managing their diabetes, as found by an eight-point better score on the Problem Areas in Diabetes scale than the medical group. Problems surveyed included emotional distress, eating behaviours, and difficulty with diabetes self-management.
Although the Why WAIT program improved self-reported physical and mental health more than gastric bypass did at three months, improvements were generally similar in the two groups after one and two years of follow-up and were in the moderate range.
Heart diseaseThe researchers also reported that obese patients with T2DM who a gastric bypass reduces their risk of heart disease.
When they compared the effectiveness for cardiometabolic outcomes of bariatric surgery vs. intensive medical weight management at 12 months, there was greater reduction in weight (-28±2 vs -7±2 kg; RYGB vs IMWM, p<0.0001) and fat mass by bioelectrical impedance (-23±1 vs -6±2 kg, p<0.0001) post-RYGB; and at 18-24 months, weight loss (-29±2 vs -5±2 kg, p<0.0001) and loss of fat mass (-23±2 vs -2±2 kg, p<0.0001) were sustained post-RYGB. HbA1c reduction was greater post-RYGB (-2.0±0.4 vs 0.0±0.4, p<0.001) at 12 months and maintained at 18-24 months (-1.7±0.4 vs -0.2±0.3, p<0.01). Reductions in systolic blood pressure (BP) (-12±3 vs -1±3, p<0.05) and triglycerides (-47±9 vs -5±9, P<0.001) and increase in HDL (10±2 vs 0±2, p<0.001) were greater post-RYGB at 12 months.
At 18-24 months improvement in systolic BP (-10±5 vs 7±3, P<0.01) and HDL (15±4 vs 2±2, P<0.05) were maintained, and reduction in diastolic BP (-9±3 vs 1±2, P<0.05) emerged only post-RYGB.
Changes in UKPDS cardiometabolic risk scores from baseline of 10.3±8.2% for coronary heart disease (-2.8±1.2 vs 0.3±1.0%, p<0.05), 6.7±6.4% for fatal coronary heart disease (-2.1±1.0 vs 0.7±0.7%, p<0.05), 4.0±3.3% for stroke (0.23±0.25 vs 1.04±0.25%, p<0.05) and 0.54±0.49% for fatal stroke (-0.04±0.06 vs 0.19±0.05%, p<0.01) were all more favourable at 18-24 months following bypass.
“There is emerging evidence highlighting the potential health benefits of bariatric surgery in managing obese patients with Type 2 diabetes,” said Dr Su Ann Ding, a research fellow at Joslin. “In the past, lifestyle advice and medications provided the mainstay of treatment for this group of patients, but despite the substantial improvements in pharmacotherapy for adults with Type 2 diabetes, many patients still do not achieve targeted health goals. Roux-en-Y gastric bypass surgery is an acceptable therapeutic option for risk reduction in heart disease in obese patients with Type 2 diabetes in whom surgical risk is not excessive.”