Does gastric bypass surgery confer benefit in T2D beyond diet alone?

  • Yoshino M & al.
  • N Engl J Med
  • 20 Aug 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In patients with obesity and type 2 diabetes (T2D), matched weight loss from gastric bypass surgery (GBS) vs diet alone produced nearly identical metabolic benefits.

Why this matters

  • In trials, greater T2D remission has been seen with bariatric surgery vs medical therapy.
  • Some findings have suggested unique glycemic benefits with GBS, but weight loss was not matched.

Study design

  • Glucose homeostasis regulators analyzed before and after weight loss via GBS or diet alone in patients with T2D and obesity.
  • Funding: NIH; Foundation for Barnes-Jewish Hospital; Pershing Square Foundation.

Key results

  • Of 33 patients, 22 (11/group) achieved ≥16% weight loss.
    • Mean of 17.8% with diet. 
    • Mean of 18.7% with GBS.
  • 4-hour postprandial area under curve for plasma glucose and insulin dropped after weight loss in both groups. 
    • Glucose decrease was greater with diet:
      • −20.8 vs −10.1 (95% CI, 1.1-16.0) mg/dL × minutes × 103.
    • Insulin did not differ:
      • −5.6 vs −4.6 (95% CI, −7.5 to 0.5) µU/mL × minutes × 103.
  • Liver, skeletal muscle, and adipose tissue insulin sensitivity and beta-cell function all increased similarly in both groups.
  • However, with GBS vs diet:
    • Greater decrease in 24-hour plasma branched-chain amino acid and C3/C5 acylcarnitine;
    • Greater gut microbiome changes; and
    • Plasma bile acids were increased, whereas they were decreased with diet.

Limitations

  • Not randomized.
  • Small sample/high dropout rate.