Gastric bypass or biliopancreatic diversion increases remission from type 2 diabetes in obese adults

A randomized controlled trial (RCT) of 60 severely obese adults with type 2 diabetes found that gastric bypass or biliopancreatic diversion increased diabetes remission more than medical therapy.

The study was published in New England Journal of Medicine on April 26. The following commentary by Suma Pokala, MD, FACP, was published in the ACP Journal Club section of the July 17 Annals of Internal Medicine.

Bariatric surgery has been in vogue for > 15 years and has been shown to decrease BMI and improve glycemic control or even resolve type 2 diabetes.

In the RCT by Mingrone and colleagues, diabetes remission and glycemic control were more common in the surgical groups than in the medical therapy group. Preoperative body mass index and weight loss did not predict improvement in hyperglycemia. Trial results, however, were too imprecise to rule out differences in weight loss, metabolic parameters, or diabetes remission between biliopancreatic diversion and gastric bypass at 2 years.

Mingrone and colleagues measured surrogate markers for clinical outcomes. Two years seems sufficient to detect effects on glycemic control and diabetes remission. Given the progressive nature of type 2 diabetes, longer follow-up could help characterize with greater precision the extent to which these benefits are sustained over time. Further ascertainment of the nature and frequency of surgical complications associated with different procedures, surgical experience and volume levels, and patient characteristics would be helpful in decision making. Longer, larger multicenter studies measuring such patient-important outcomes as mortality, morbidity, end-organ damage, functional capacity, and quality of life are needed. The findings of Mingrone and colleagues add to the body of evidence favoring bariatric surgery but, alone, should not result in a rush to do more surgeries.