Intensive weight management, bariatric surgery yield similar results in type 2 diabetes

Intensive weight management, bariatric surgery yield similar results in T2D
Intensive weight management, bariatric surgery yield similar results in T2D

SAN DIEGO — For obese patients with type 2 diabetes, both bariatric surgery and an intensive medical weight management program were effective for weight loss, improving glucose control, and patient-reported quality of life, according to data presented at ENDO 2015.

“In patients with type 2 diabetes, reduced health status and quality of life are often associated with symptoms of poor glycemic control, high glycemic variability, presence of diabetes complications and many other issues,” Donald C. Simonson, MD, MPH, ScD, of Harvard University in Boston, said during a presentation.

To compare the differential effects of patient-reported outcomes after weight loss achieved by laparoscopic adjustable gastric band (LAGB) or an intensive medical diabetes and weight management program (IMWM), the researchers evaluated weight loss, HbA1c levels and self-reported mental, physical and quality of life health scores in 40 patients diagnosed with type 2 diabetes who were randomly assigned to undergo LAGB surgery (n=18) or a 12-week multidisciplinary IMWM program (n=22).

Patients' mean age was 51 years; mean duration of type 2 diabetes was 9 years; mean HbA1c level was 8.2%; and mean BMI was 36.5. Follow-up lasted 12 months.

At baseline, both groups had comparable SF-36 physical health (76) and mental health (75) status scores as well as moderately elevated Impact of Weight on Quality of Life (IWQOL) and Problem Areas in Diabetes (PAID) scores (59 and 46, respectively).

After achieving 10% weight loss or after 3 months if 10% weight loss was not achieved, the researchers observed “highly significant and nearly identical” weight loss in both groups (LAGB, –9.7 kg vs. IMWM, –9.2 kg), according to Simonson. Improvements in HbA1c were also similar (LAGB, –1.0% vs. –1.7%; P=.06).

The researchers also noted that SF-36 physical health and self-reported mental health scores improved minimally from baseline, with no significant differences between the LAGB and IMWM groups.

At 12 months, weight loss was significantly greater after LAGB (–13.5 kg vs. –8.5 kg; P<.05), but there was no difference in lowering of HbA1c (–1.2% vs. –1.0%), according to the study results.

SF-36 physical health and mental health scores changed minimally compared with the earlier assessment, with no differences between groups. Significant improvements in IWQOL (–14 vs. –11) and PAID (–13 vs. –13) from baseline were found in both LAGB and IMWM, respectively (P<.01 vs. baseline for both groups), but the effects were similar.

Data also delineated a correlation between improvement in HbA1c and patient's self-assessment of diabetes-specific emotional distress as assessed by PAID (P<.01) in both treatment groups.

In light of these results, the researchers concluded that, in obese patients with type 2 diabetes, both LAGB and IMWM result in significant weight loss and reductions in HbA1c, according to the data. Although weight loss was significantly greater after LAGB, improvement in HbA1c was similar in both treatment arms, they noted.

Further, both treatments are associated with moderate and comparable changes in self-reported physical and mental health status SF-36 scores, and both treatments are associated with significant reductions on the impact of weight on quality of life and problem areas in diabetes.

“Both treatments should be considered effective options for improving weight, glucose control, health status and quality of life in obese patients with type 2 diabetes,” Simonson said.

References

  1. Simonson DC et al. Abstract OR01-2. Presented at: The Endocrine Society's 97th Annual Meeting & Expo (ENDO 2015); March 5-8, 2015; San Diego.
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