F.Y.Eye

Abstract

American researchers conducted a randomized trial of 2 surgical treatments for obese patients with diabetes with a body mass index of 30 to 40, compared with intense lifestyle modifications. It was a small study, involving randomization of 69 participants to either intensive lifestyle weight-loss intervention (LWLI), Roux-en-Y gastric bypass (RYGB), or laparoscopic adjustable gastric banding (LAGB). The researchers screened 667 potential participants; of these, 69 were randomized and a subsequent 7 refused further participation. Twenty patients underwent RYGB, 12 had LAGB, and 20 did LWLI. The RYGB group had the greatest mean weight loss of 27% (95% CI 30.8 to 23.3, p < 0.001), compared with 17.3% for LAGB (95% CI 21.1 to 13.5) and 10.2% for LWLI (95% CI 14.8 to 5.61). When the rates of diabetic remission were assessed, the RYGB had 50% partial and 17% complete remission, whereas the rates were 27% and 23% in the LAGB group and 0 in the LWLI group (p < 0.001 and p = 0.047 between groups for partial and complete remission). The authors concluded that their study highlighted the difficulties in conducting large, randomized studies comparing surgery with lifestyle modification, but that surgery appears to be promising in this group of patients.