In a new study from Columbia University, researchers found bariatric surgery—either gastric bypass or sleeve gastrectomy—is recommended for people with type 2 diabetes and a body mass index of 40 or above.
They used data from previous studies and databases and created a model to investigate the effectiveness of gastric bypass, sleeve gastrectomy, and medical therapy among patients over a five-year period.
Gastric bypass is a more complex procedure than sleeve gastrectomy, and previous studies show it is associated with more complications.
Gastric bypass creates a small pouch in the stomach that is attached to the small intestine, so that food bypasses much of the stomach and some of the small intestine.
After the surgery, less food can be ingested and absorbed. In sleeve gastrectomy, the stomach is permanently reduced to about one-quarter its original size, but no bypass is created.
The current study found that gastric bypass leads to greater weight loss and a greater rate of remission of diabetes than sleeve gastrectomy or medical therapy, which involves lifestyle counseling and medication.
Gastric bypass surgery also could produce the best results regardless of diabetes severity.
The team says determining which groups may benefit from a specific strategy is an important step toward personalized medicine.
This study suggests that in most cases, gastric bypass is the preferred strategy, despite higher upfront surgical costs and complications, and becomes even more cost-effective when considered over 10 or 30 years.
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The study is published in JAMA Network Open and was conducted by Chin Hur et al.
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