Bariatric surgery bests medical treatment in Asians with diabetes, class I obesity

Roux-en-Y gastric bypass (RYGB) appears to produce more favourable improvements in terms of glycaemic control and weight loss when compared with medical treatment in Asian patients with type 2 diabetes mellitus (T2DM) and class I obesity, according to a study.

Researchers conducted a 5-year single-centre, open-label randomized controlled trial to compare the effects of gastric bypass against that of medical therapy with newer classes of glucose-lowering drugs. They enrolled 28 patients with T2DM and class I obesity.

Of the patients randomized to either RYGB or medical treatment, 26 were included in the final analysis (14 medical, 12 RYGB; mean age 44 years, 34.6 percent male, mean body mass index [BMI] 29.4 kg/m²). At the 12-month follow-up, the primary endpoint of diabetes remission (defined as HbA1c ≤6 percent or ≤42 mmol/mol and discontinuation of glucose-lowering medication) occurred only in the RYGB group.

In particular, 50 percent of patients who underwent RYGB achieved diabetes remission, while 83 percent were able to withdraw all glucose-lowering medications. By year 5, 42 percent of patients in the RYGB group were in remission. On the other hand, none of those in the medical group attained remission.

The RYGB group also achieved greater reductions in fasting plasma glucose, HbA1c, and BMI compared with the medical treatment group (all p<0.05). Nevertheless, the two groups showed similar early improvements in glycaemic variability and time in range.

In terms of safety, some patients in the RYGB group developed hypoglycaemia and surgical complications.