Adding gastric bypass surgery to lifestyle and intensive medical management appears to improve certain outcomes over 5 years better than the latter alone, according to an observational follow-up of a randomized trial involving 120 individuals. Participants averaged age was 49 years, had HbA1c ≥8.0%, and BMI between 30.0 and 39.9. They received lifestyle-intensive medical management for 2 years either with (n=60) or without (n=60) Roux-en-Y gastric bypass surgery. Investigators looked for a composite of HbA1c <7.0%, LDL cholesterol <100 mg/dL, and systolic blood pressure <130 mm Hg. Among the results:

• 98 patients completed 5 years of follow-up.
• 23% of patients who received gastric bypass achieved the composite, vs 4% in the contingent who did not undergo surgery.
• Target HbA1c level was reached in 55% and 7%, respectively.
• There were more serious adverse events in the surgery group (66 vs 39).
• Patients in the surgery group experienced more parathyroid hormone elevation.

The authors noted that because the effect size diminished over time, durability of the improvement is unknown.