Efficacy of the Roux-en-Y gastric bypass compared to medically managed controls in meeting the american diabetes association composite end point goals for management of type 2 diabetes mellitus

Daniel B. Leslie, Robert B. Dorman, Federico J. Serrot, Therese W. Swan, Todd A. Kellogg, Gonzalo Torres-Villalobos, Henry Buchwald, Bridget M. Slusarek, Barbara K. Sampson, John P. Bantle, Sayeed Ikramuddin

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background: The treatment goals recommended by the American Diabetes Association (ADA) for patients with type 2 diabetes mellitus include hemoglobin A1c (HbA1C) <7.0%, low-density lipoprotein (LDL) <100 mg/dL, and systolic blood pressure (SBP) <130 mmHg. Only 10% of conventionally treated patients reach these goals as a composite endpoint. The efficacy of the Roux-en-Y gastric bypass (RYGB) in meeting this composite endpoint has not been reported. Methods: We compared our database of patients with type 2 diabetes undergoing RYGB to a database of patients with medically managed type 2 diabetes and at least 2 years of follow-up data. Results: Ultimately, 152 RYGB patients were compared to 115 routine medical management (RMM) patients for whom data on the composite endpoint were available over 2 years. The results show significant decrease in body mass index (kilograms per square meter) in the RYGB group compared to the RMM group (P<0.001). HbA1C, LDL cholesterol, and SBP all significantly improved in the RYGB group (all P≥0.01) and did not demonstrate any significant change in the RMM group. Over 2 years, when evaluating all three endpoints, the RYGB group (10.5% to 38.2%, P<0.001) demonstrated increased achievement of the ADA goals compared to the RMM group (13.9% to 17.4%, P=0.47). There was a significant decrease in medication use in the RYGB cohort; however, discontinuation of medications was sometimes inappropriate. Conclusions: RYGB achieves the ADA composite endpoint more frequently than conventional therapy and with less medication.

Original languageEnglish (US)
Pages (from-to)367-374
Number of pages8
JournalObesity Surgery
Volume22
Issue number3
DOIs
StatePublished - Mar 2012

Bibliographical note

Funding Information:
Conflicts of interest Robert Dorman receives a grant from Ethicon for salary support during his research fellowship. Sayeed Ikramuddin receives research funding support from both Ethicon and Covi-dien. Daniel Leslie is a consultant for Ethicon Endo-Surgery. Henry Buchwald consults for MetaCure, Ethicon Endo-Surgery, and receives research support from Ethicon Endo-Surgery, Meta-Cure, and Gore.

Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.

Keywords

  • Bariatrics
  • Cardiovascular disease
  • Diabetes
  • Roux-en-Y gastric bypass

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