Study limitations: Small, not randomized, long diabetes duration
The authors acknowledged some of the study’s limitations, including the fact that it wasn’t randomized and there was a large number of dropouts, although they say that the method used to assess the primary outcome can detect small differences even in a few patients.
The editorialists – endocrinologist Clifford J. Rosen, MD, director of the Center for Clinical and Translational Research at Maine Medical Center Research Institute, Scarborough, and pediatric nephrologist and deputy editor for the New England Journal of Medicine Julie R. Ingelfinger, MD, of Massachusetts General Hospital, Boston – pointed out that today more sleeve gastrectomies are performed than Roux-en-Y bypass procedures.
However, Dr. Hutter said that gastric bypass procedures are still being performed, that both procedures are effective and safe, and that for patients with diabetes the bypass tends to be somewhat more effective than sleeve gastrectomy.
He also qualified: “What phase you’re in is critical. Here, the 18% [weight loss] is still early in the track for bariatric surgery. They could still be losing weight after that. The diet groups could have been in the plateau or regain phase. Those [numbers] could look very different with time.”
In addition, he noted that the relatively long average duration of diabetes in the study participants makes the success of bariatric surgery less likely.
“The pancreas burns out, and the tissues become less insulin sensitive. I would have wanted to stratify the patients into early versus later disease, but you would need a larger sample size to do that,” he said.
Dr. Hutter noted: “I thought the study was very interesting. It just amazes me that 60 years after the gastric bypass procedure was invented, we’re still trying to figure out how it works.”
Dr. Hutter is a consultant for Vicarious Surgical and has received honoraria from Ethicon, Medtronic, and Olympus.
A version of this article originally appeared on Medscape.com.