Surgery vs Diet Improves Diabetes Patients’ Quality of Life

An intensive weight-loss program involving lifestylemodifications improves obese diabetes patients’ physical and mental health as well as gastric bypass surgery does over two years, but the weight-loss surgery leads to a greater reduction in adverse effects of obesity on quality of life. These results, from a new study in patients with type 2 diabetes, were presented at the joint meeting of the International Society of Endocrinology and the Endocrine Society.

Gastric bypass also led to patients having a somewhat greater reduction in problems associated with managing their diabetes, according to the study’s lead investigator Donald Simonson, MD, MPH, ScD, from Brigham and Women’s Hospital in Boston. “Patients with obesity and type 2 diabetes should consider these long-term results when making decisions about their weight-loss treatment,” he said.

The researchers evaluated the effects of weight loss on 38 patients’ self-reported health status for both physical and mental health as well as the impact of their weight on their quality of life and problem areas in managing their type 2 diabetes.

Fifteen men and 23 women participated in the Surgery or Lifestyle With Intensive Medical Management in the Treatment of Type 2 Diabetes (SLIMM-T2D) trial. Of the 38 patients, 19 were randomly assigned to undergogastric bypass surgery at Brigham and Women’s Hospital and 19 patients to a medical diabetes and weight management program called Why WAIT (Weight Achievement and Intensive Treatment) at the Joslin Diabetes Center in Boston. The program consisted of exercise, diet with meal replacements, 12 initial weekly group sessions, and nine additional months of individual counseling. Follow-up evaluation ranged from 18 to 24 months.

Before treatment, patients reported high scores on the questionnaire Impact of Weight on Quality of Life, which included physical function, self-esteem, sex life, public distress, and work. Up to two yearsafter treatment, patients who underwent gastric bypass surgery had nearly twice the improvement (reduction) in the adverse effects of weight on their quality of life, which Simonson said strongly correlated with the greater amount ofweight they lost. Two years after treatment, the surgical patients lost an average of 64.4 lbs vs. 11 lbs in the Why WAIT group, he noted.

At 18 to 24 months after treatment, patients in the surgical group also reported a 60% greater reduction in problems with managing their diabetes, as found by an 8-point better score on the Problem Areas inDiabetes scale than the medical group. Problems surveyed included emotionaldistress, eating behaviors, and difficulty with diabetes self-management.

Although the Why WAIT program improved self-reportedphysical and mental health more than gastric bypass did at three months, improvements generally were similar in the two groups after one and two years of follow-up and were in the moderate range, Simonson reported.

Source: Endocrine Society