Long-term outcomes comparing metabolic surgery to no surgery in patients with type 2 diabetes and body mass index 30-35.

BACKGROUND

We previously conducted a randomized study comparing metabolic surgery with medical weight management in patients with type 2 diabetes (T2D) and body mass index (BMI) 30 to 35 kg/m. At 3-year follow-up, surgery was very effective in T2D remission; furthermore, in the surgical group, those with a higher baseline soluble receptor for advanced glycation end products had a lower postoperative BMI.

OBJECTIVES

To provide long-term follow-up of this initial patient cohort.

SETTING

University Hospital.

METHODS

Retrospective chart review was performed of the initial patient cohort. Patients lost to follow-up were systematically contacted to return to clinic for a follow-up visit. Data were compared using 2-sample t test, Fisher's exact test, or analysis of variance when applicable.

RESULTS

Originally, 57 patients with T2D and BMI 30 to 35 kg/m were randomized to metabolic surgery (n = 29) or medical weight management (n = 28). Ten patients in the medical weight management group crossed over to surgery. Five-year follow-up data were available in 43 of 57 (75%) patients. Baseline mean BMI and glycated hemoglobin were 32.6 kg/m and 7.8%, respectively. Median follow-up was 79 and 88 months in the surgical group and nonsurgical group, respectively. Compared with the nonsurgical group, the surgical patients had significantly lower rate of T2D (62% versus 100%; P = .008), lower insulin use (10% versus 50%; P = .0072), lower glycated hemoglobin (6.93% versus 8.26%; P = .012), lower BMI (25.8 versus 28.6 kg/m; P = .007), and higher percent weight loss (21.4% versus 10.3%; P = .025). Baseline soluble receptor for advanced glycation end products was not associated with long-term outcomes.

CONCLUSIONS

Metabolic surgery in T2D patients with BMI 30 to 35 kg/m remains effective long term. Baseline soluble receptor for advanced glycation end products are most likely predictive of early outcomes only.