Obese individuals with type 2 diabetes mellitus experienced a remission of their diabetes after bariatric surgery followed by 2 years of lifestyle weight loss intervention, according to a recent randomized clinical trial. Those who had 3 years of lifestyle modification alone—1 year of intensive weight loss counseling followed by 2 years of twice-monthly sessions focused on weight loss strategies—saw no remission of their diabetes. The study provided important data on the surgical treatment of individuals with class I obesity (body mass index of 30 to <35), who have previously been excluded from bariatric surgical trials. The trial also assessed type 2 diabetes remission among individuals who received laparoscopic adjustable gastric banding (LABG), a reversible and low-risk procedure that may be a better surgical alternative for those with lower body mass index (Courcoulas AP et al. JAMA Surg. doi:10.1001/jamasurg.2015.1534 [published online July 1, 2015]).
The 61 participants were randomly assigned to either 3 years of lifestyle weight loss intervention alone or to the surgical procedure Roux-en-Y gastric bypass (RYGM) or LAGB followed by low-level lifestyle intervention in years 2 and 3. More than 40% of the total participants had class I obesity.
At 3 years, partial or complete type 2 diabetes remission was achieved in 40% of participants who had RYGB, and in 29% of those who had LAGB, but in none of the participants who had the lifestyle weight loss intervention alone. The study also found that 72% of individuals in the RYGB group and 45% in the LAGB group did not require any diabetes medications at 3 years. Patterns of outcomes between intervention groups did not differ significantly by obesity class.
Although the study was limited by small sample size, it provides valuable longer-term 3-year follow-up results that include LAGB as an alternative surgical intervention.