The Particulars: Few studies have compared intensive medical therapy with bariatric surgery in the management of uncontrolled type 2 diabetes in obese patients.

Data Breakdown: For a study, patients with uncontrolled diabetes for 8 or more years were randomized to receive intensive medical therapy only, intensive medical therapy plus Roux-en-Y gastric bypass, or intensive medical therapy plus sleeve gastrectomy. The average participant was mildly to moderately obese, aged 41 to 57, had a baseline A1C of 9.3% and was taking three or more anti-diabetic medications and three or more cardiovascular medications. At 3 years, 5% of patients in the medical therapy group achieved an A1C of 6% or less, compared with 37.5% in the gastric bypass group and 24.5% in the sleeve gastrectomy group. The surgical groups also showed greater improvement in metabolic syndrome components, use of antihypertensive and lipid-lowering medications, and kidney function.

Take Home Pearls: Gastric bypass and sleeve gastrectomy, when combined with intensive medical therapy, appear to be more effective at 3 years than intensive therapy alone in managing uncontrolled type 2 diabetes in obese patients.