RESUMO
CONTEXT: Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment. OBJECTIVE: Compare the remission of T2DM following surgical or nonsurgical treatments. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016. INTERVENTIONS: 61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years. MAIN OUTCOMES AND MEASURES: Diabetes remission assessed at 5 years. RESULTS: The mean age of the patients was 47â ±â 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8%â ±â 1.9%, body mass index (BMI) 35.7â ±â 3.1 kg/m2, and 26 participants (43%) had BMIâ <â 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (nâ =â 6) of RYGB, 19% (nâ =â 4) of LAGB, and no LWLI participants (Pâ =â .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (Pâ =â .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2%â ±â 2.1%, followed by LAGB 12.7%â ±â 2.0% and lifestyle treatment 5.1%â ±â 2.5% (all pairwise Pâ <â .01). CONCLUSIONS: Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.