Diabetes, Heart and Cardiovascular Diseases News Chronicle.  Diabetes, Cardiovascular and Heart Diseases
 Article 331
    Published on June 27, 2018

Gastric bypass surgery RYGB can give you a better control of type 2 diabetes and obesity than lifestyle modification

Even though it is possible to reduce the body weight and high blood glucose levels by participating in an intensive lifestyle modification program, it is difficult to stick to those measures for a longer period. The following options are available for a severely obese patient with a poorly controlled diabetes to reduce blood glucose levels.

  • Participating in an intensive lifestyle modification program such as a regular exercise, eating the healthy and low glycemic index food, by reducing daily calorie intake, by avoiding alcohol consumption and smoking habit and by reducing stress.
  • Undergoing a gastric bypass surgery to reduce obesity, as the obesity is linked to high blood sugar levels.

The current guidelines suggest a Bariatric surgery to reduce body weight for people with a body mass index (BMI) of over 40 kg/m2 or for people with obesity-associated diseases such as type 2 diabetes (T2D) with a body mass index (BMI) over 35 kg/m2. Earlier studies show a reversal of type 2 diabetes with a Bariatric surgery among obese people having high blood sugar levels. But some health care professionals hesitate to recommend a Bariatric surgery to patients with type 2 diabetes with mild obesity.

But this trial shows patients with an uncontrolled (or a poorly controlled) blood glucose levels and with mild obesity can be benefited from the Bariatric surgery.

A three-year-long randomized SLIMM-T2D (Surgery or Lifestyle with Intensive Medical Management in the Treatment of Type 2 Diabetes) study has found that 58 percent of those patients who underwent a bypass surgery called Roux-en-Y gastric bypass (RYGB) has achieved A1C levels of less than 7 percent when compared to 11 percent of patients who underwent Joslin's Why WAIT intensive lifestyle management program.

Other improvements are a reduction in the risk of cardiovascular disease and improvement in the obesity-related quality of life. Researchers from both Joslin Diabetes Center and Brigham and Women's Hospital have conducted this study.

Researchers have conducted a randomized study among 38 obese type 2 diabetes patients (15 men and 23 women), aged between 46 and 58 years with a body mass index between 33 to 44 kg/m2. Researchers randomly selected 19 patients to the laparoscopic Roux-en-Y gastric bypass RYGB and the remaining patients to the Intensive Medical Diabetes and Weight Management (IMWM).

Patients under medical diabetes and weight-management program have participated in the exercise programs, changed their diet, took medications to increase the weight loss and participated in the educational classes. All of them have high blood sugar levels (HbA1c levels between 7.2 to 9.8). Researchers assessed following health parameters.

  • The change in the body weight.
  • The change in the blood sugar levels (HbA1c).
  • The change in the cardiovascular risk factors.
  • Self-reported health status of each participant (Short-Form SF-36 survey).

Researchers used following tools in the study

  • "Problem Areas in Diabetes" (PAID) instrument to determine emotional distress in a patient.
  • "Assessing the Impact of Weight on Quality of Life in Adults" (IWQOL) instrument.
  • UKPDS (United Kingdom Prospective Diabetes Study) risk engine calculator. This tool provides the unknown heart disease risks such as coronary heart disease and stroke in a type 2 diabetes patient.

The study results show

Health event Result
Weight loss In patients under IMWM group, researchers have observed good weight loss and reduced blood sugar levels during the initial stages, but there are no improvements over time. Less than 10 percent of the patients have achieved weight loss with lifestyle modifications. Patients under the bypass surgery have lost 55 pounds (lbs) of weight on an average when compared to just 11 pounds (lbs) on an average in patients under the IMWM group.
Blood sugar levels Patients under the bypass surgery have reduced their HbA1c levels by 1.79 percent compared to just 0.39 percent in patients under the IMWM group.
IWQOL score There was a greater improvement in IWQOL score in the surgical cohort people. The improvement was due to subscales of physical function, work performance, and self-esteem. The study has found the improvement in the overall quality of life was strongly linked with the body weight loss compared with HbA1c levels.
PAID score and SF-36 There was an improvement in the 36-Item Short-Form (SF-36) survey and PAID scores in patients in both the IMWM and the bypass surgery groups. The study has found no difference between treatments.
Reduction in cardiovascular health risks In the bypass surgery cohort, researchers have observed a marked reduction in cardiometabolic and cardiovascular risk. This trial has found a reduction in risk factors for coronary heart diseases and strokes such as blood pressure or hypertension, triglycerides (high fat in the blood), low HDL (GOOD) cholesterol, high LDL (BAD) cholesterol and usage of insulin in the body (insulin resistance).
Other benefits After the bypass surgery, patients used lower medications and pills to control their blood cholesterol levels, blood sugar levels, and blood pressure.

Authors say their study shows even a type 2 diabetes patient with mild to moderate obesity, gastric bypass surgery can help in achieving sustained weight loss, reducing cardiovascular risk and HbA1c levels (improved diabetes management) compared to medical diabetes and weight management program. Medical diabetes and weight management program include lifestyle modifications such as eating healthy and low glycemic index foods, regular exercise, avoiding alcohol and smoking and reducing stress etc.

Gastric bypass surgery RYGB can give better control of type 2 diabetes, obesity than lifestyle modification.

Lead author of the study was Donald C. Simonson, MD, MPH, ScD, Lecturer on Medicine, Brigham and Women's Hospital, Boston, United States. Co-authors of the study were Allison B. Goldfine, Ashley Vernon, Florencia Halperin and Kathleen Foster. The study findings were published February 2018 in the Diabetes Care. Title of the article was "Clinical and Patient-Centered Outcomes in Obese Patients With Type 2 Diabetes 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study." DOI : doi.org/10.2337/dc17-0487

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