Roux-en-Y gastric bypass versus best medical treatment for type 2 diabetes mellitus in adults with body mass index between 27 and 32 kg/m2: A 5-year randomized controlled trial

• Published in: Diabetes research and clinical practice Vol. 188; p. 109900
• Main Authors: Cheng, Anton, Yeoh, Ester, Moh, Angela, Low, Serena, Tan, Chun Hai, Lam, Benjamin, Sum, Chee Fang, Subramaniam, Tavintharan, Lim, Su Chi
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.06.2022
• Subjects: Class I obesity; Continuous glucose monitoring; Glucagon-like peptide 1 receptor agonist; Roux-en-Y gastric bypass; Sodium-glucose cotransporter 2 inhibitor; Type 2 diabetes mellitus; Continuous glucose monitoring; Roux-en-Y gastric bypass; Type 2 diabetes mellitus; Sodium-glucose cotransporter 2 inhibitor; Glucagon-like peptide 1 receptor agonist; Class I obesity
• ISSN: 0168-8227; 1872-8227; 1872-8227
• DOI: 10.1016/j.diabres.2022.109900

•Asians are at increased risk for developing T2DM at lower body mass index.•The effect of gastric bypass vs best medical therapy is not well-studied in Asians.•In this randomized controlled trial, surgery outperformed best medical treatment.•Greater improvements in glycaemic control and weight were observed after surgery.•Gastric bypass was associated with lower cost compared with medical treatment. To evaluate the effects of Roux-en-Y gastric bypass (RYGB) versus best medical treatment in Asians with type 2 diabetes mellitus (T2DM) and class I obesity. In this 5-year single-centre, open-label randomized controlled trial, participants were randomized to RYGB or medical treatment including newer classes of diabetes medications (ClinicalTrials.gov:NCT02041234). The primary endpoint was diabetes remission defined as HbA1c ≤ 6% (≤42 mmol/mol) and discontinuation of glucose-lowering medication at 12 months post-intervention and beyond. Glycaemia and weight changes were assessed. Continuous glucose monitoring was performed. Of 28 subjects randomized, 26 were analyzed in the final cohort (14 medical, 12 RYGB; age:44 ± 10 years, 34.6% males, BMI:29.4 ± 1.6 kg/m2). At 12 months, 50% of RYGB subjects achieved diabetes remission; 83% stopped all glucose-lowering medications. By year 5, 42% were in remission. None attained diabetes remission in the medical group. Percentage declines in fasting plasma glucose, HbA1c and BMI were significantly greater in the RYGB arm (all P < 0.05). Early improvements in glycaemic variability and time in range were similar in both treatment arms. Hypoglycaemia and surgical complications were observed in some RYGB subjects. Over 5 years, RYGB outperforms best medical treatment in glycemia and weight improvements for Asians with T2DM and class I obesity.