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U of M expert: Gastric bypass surgery more effective at controlling type 2 diabetes than intensive lifestyle medical management

Editor’s note: For more news of the JAMA study please visit our Storify page.

New research from researchers at the University of Minnesota Medical School shows that Roux-en-Y gastric bypass surgery is twice as effective for the control of type 2 diabetes, hypertension and hyperlipidemia when compared to intensive lifestyle medical management consisting of dietary change, physical activity, exercise and medication.

The study, “Roux-en-Y Gastric Bypass vs. Intensive Medical Management for the Control of Type 2 Diabetes, Hypertension, and Hyperlipidemia” appears in the June 5, 2013, issue of the Journal of American Medical Association (JAMA), and was led by Sayeed Ikramuddin, M.D., professor of surgery at the University of Minnesota.

“Within our study, the level of success hinged primarily upon the amount of weight the individual lost,” said Ikramuddin. “Simply stated the more weight you lose the better you’re able to combat the conditions in question.”

Here’s what the study found:

To arrive at their results, researchers examined 120 patients from the U.S. and Taiwan with hemoglobin levels of 8.0 percent or higher, body mass indexes (BMI) between 30.0 and 39.9, C peptide levels of more than 1.0 ng/ml, and who had suffered type 2 diabetes for at least 6 months. Of the 120 patients, 60 received intensive lifestyle medical management and 60 were randomly selected to undergo Roux-en-Y gastric bypass surgery.

The composite goal for the study was established by the American Diabetes Association (ADA) for the treatment of diabetes: a glucose lab test known as HbA1c showing less than a 7.0 percent blood sugar average, low-density lipoprotein cholesterol less than 100 mg/dL, and systolic blood pressure less than 130 mm Hg.

After 12 months, participants who underwent Roux-en-Y gastric bypass surgery had an overall success rate (reaching composite goal) of 49 percent. The group who participated in intensive lifestyle medical management saw a success rate of 19 percent.

The gastric bypass group lost an average of 26.1 percent of initial body weight compared to 7.9 percent for the intensive lifestyle medical management group. The gastric bypass group on average used three fewer medications to manage glycemia, dyslipidemia, and hypertension than did those in the intensive lifestyle medical management group.

Ikramuddin warns that surgery is not a cure-all for type 2 diabetes, hypertension and hyperlipidemia control. However, surgery was associated with a greater likelihood of achieving the composite goal.

“Surgery for the right patient can improve medical outcomes and dramatically reduce the rates of type 2 diabetes, hypertension and hyperlipidemia,” said Ikramuddin. “It’s important to carefully examine with your doctor the potential benefits of adding gastric bypass surgery to the best lifestyle and medical management strategies against the risk of serious adverse events.”

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