A study compared two-year outcomes between conservative management (intensive lifestyle and medical management) and surgical management (lifestyle and medical management plus Roux-en-Y gastric bypass surgery. Participants were aged 30-67 with BMI 30-39.9 and HbA1c of at least 8.0%, with type 2 diabetes for at least six months. The goals were HbA1c less than 7.0%, LDL cholesterol less than 2.59mmol/L and systolic BP less than 130mmHg at 12 months. Forty three percent of surgical patients achieved this, and fourteen percent of controls (OR 5.1,95%CI 2.0-12.6). Adverse events (mainly falls and fractures) and nutritional deficiencies (mainly iron, albumin, calcium and vitamin D) were more frequent. Larger and longer studies are needed before the benefits and risk of gastric bypass for type 2 diabetes can be balanced (Ikramuddin et al., 2015).
IKRAMUDDIN, S., BILLINGTON, C. J., LEE, W. J., BANTLE, J. P., THOMAS, A. J., CONNETT, J. E., LESLIE, D. B., INABNET, W. B., 3RD, JEFFERY, R. W., CHONG, K., CHUANG, L. M., SARR, M. G., JENSEN, M. D., VELLA, A., AHMED, L., BELANI, K., SCHONE, J. L., OLOFSON, A. E., BAINBRIDGE, H. A., LAQUA, P. S., WANG, Q. & KORNER, J. 2015. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol, 3, 413-22.