At that time point, patients who’d had surgery kept off significantly more weight than those who had the lifestyle program, losing 29 kg compared with only 5 kg (P<0.001), Su Ann Ding, MD, of Joslin Diabetes Center, and colleagues reported at the joint meeting of the Endocrine Society and the International Congress on Endocrinology here.
Greater improvements in blood sugar control and cardiovascular risk factors were also sustained through that time, Ding said.
The researchers conducted the Surgery or Lifestyle with Intensive Medical Management in the Treatment of Type 2 Diabetes (SLIMM-T2D) trial to look at the efficacy of intensive lifestyle management in comparison with metabolic surgery.
A total of 38 patients were randomized to either gastric bypass surgery or to an intensive lifestyle intervention.
The intervention incorporated evidence from both the Look AHEAD and Diabetes Prevention Program trials, and involved 12 weeks of dietary intervention, cognitive behavioral therapy, and medical management with pharmacologic therapy, while those in the surgery group had a Roux-en-Y gastric bypass procedure.
Ding and colleagues found that at 12 months, patients lost significantly more weight with surgery than with the intervention (28 kg [62 lbs] versus 7 kg [15 lbs], P<0.0001), which was sustained at 2 years (29 kg [64 lbs] versus 5 kg [11 lbs], P<0.001).
Surgical patients also had a greater drop in fat mass (23 kg [51 lbs] versus 6 kg [13 lbs], P<0.0001) that held at 2 years (23 kg [51 lbs] versus 2 kg [4 lbs], P<0.0001).
They also experienced greater declines in HbA1c that were sustained at 2 years (-1.7% versus -0.2%, P<0.001), as well as more robust reductions in systolic blood pressure and HDL.
And improvements in cardiometabolic risk scores for coronary heart disease and stroke were all more favorable at 2 years with surgery than with lifestyle management, Ding said.
“These findings support that gastric bypass is an acceptable therapeutic option for cardiovascular risk reduction in obese patients with diabetes in whom surgical risk is not excessive,” Ding and colleagues said.
A separate analysis of data from the SLIMM-T2D trial also showed that surgical patients garnered greater improvements in quality-of-life in the long run, according to Donald Simonson, MD, MPH, ScD, of Brigham & Women’s Hospital in Boston, and colleagues
Impact of Weight on Quality of Life (IWQOL) scores improved significantly more for surgery patients than for lifestyle patients at both 1 year (P<0.01) and at 2 years (P<0.001), they found.
Although changes in the Problem Areas in Diabetes (PAID) scores didn’t differ between groups after one year, they trended toward greater improvement for those in the surgical group by 2 years, Simonson said (P=0.06).
There were no differences, however, in health- or mental-health-related quality of life scores as measured by the SF-36 questionnaire at any time point, as both groups reported improvements in these areas.
Simonson noted that lifestyle intervention and medical therapy continue to be the standard approach to treating type 2 diabetes, but surgery could be useful for patients who don’t hit their glucose control targets as long as they are appropriate candidates.
In order for type 2 diabetes patients to be eligible for bariatric surgery, most recommendations require they have a body mass index (BMI) of 35 or greater with at least one other comorbidity.
Simonson added that the difference in patient-reported outcomes should also be considered when evaluating surgical versus medical weight loss strategies for treating type 2 diabetes in obese patients.
This information was originally published by MedPageToday.