Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia

Ikramuddin S, Korner J, Lee W-J, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia. JAMA. 2013;309(21):2240-2249.

A greater number of subjects who underwent Roux-en-Y gastric bypass surgery achieved the primary composite triple endpoint of A1C <7.0%, LDL-C <100 mg/dL, and systolic blood pressure <130 mm Hg vs those who received lifestyle and medical management at 12 months in the Diabetes Surgery Study.

Primary composite triple endpoint
In the lifestyle and medical management group, 19% (n=11) of subjects achieved the primary endpoint compared with 49% (n=28) in the gastric bypass group (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.9-11.7). A1C was the only significant treatment effect seen among the components of the triple composite endpoint: 32% (n=18) achieved A1C <7.0% in the lifestyle group vs 75% (n=43) in the gastric bypass group (OR, 6.0; 95% CI, 2.6-13.9).

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10 - Diabetes Surgery Study Greater Number of Subjects

Weight change, medication use, adverse events
Subjects in the Diabetes Surgery Study who underwent Roux-en-Y gastric bypass surgery were using fewer medications and had greater weight change at 12 months compared with patients in the lifestyle and medical management group. In the lifestyle and medical management group, subjects were using 4.8 medications (mean) for glycemia, blood pressure, and dyslipidemia, compared with 1.7 medications in the gastric bypass group (difference, -3.0; 95% CI, -3.6 to -2.3). Percent mean weight change at 1 year was -26.1% (mean) in the gastric bypass group compared with -7.9% in the lifestyle and medical management group (difference, -17.5; 95% CI, -20.7 to -14.2). Most weight loss occurred within the first 6 months, continuing through Month 12. Subjects in the gastric bypass group experienced greater serious adverse events (22) vs 15 reported from subjects in the lifestyle group.

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11 - Diabetes Surgery Study Fewer Medications

About The Diabetes Surgery Study
The Diabetes Surgery Study compared Roux-en-Y gastric bypass with lifestyle and intensive medical management for control of comorbid CVD risk factors. Subjects (N=120):

  • Aged 30-67 yrs
  • Type 2 diabetes for ≥6 months
  • A1C ≥8.0% at entry
  • C-peptide >1.0 ng/mL
  • Body mass index (BMI) 30.0-39.9 kg/m2  

All subjects received lifestyle-medical management to achieve weight loss and control glycemia and CVD risk factors. Half of subjects were randomized to Roux-en-Y gastric bypass.   

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12 - Diabetes Surgery Study Design   
 
  

September 2013 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 8/4/2014