. Author manuscript; available in PMC: 2014 Sep 10.

Published in final edited form as: Lancet Diabetes Endocrinol. 2014 Feb 3;2(2):175–181. doi: 10.1016/S2213-8587(13)70198-0

Table.

Randomised trials of surgical versus medical or lifestyle interventions, or both, for type 2 diabetes and obesity

	Interventions compared	Number of participants	Baseline BMI (kg/m²)	Follow-up length	Main findings^*
Ikramuddin et al³⁷	RYGB vs intensive medical and lifestyle care	120 adults with type 2 diabetes	30–40	1 year	Achieved composite goal^† for type 2 diabetes, hypertension, and dyslipidaemia: RYGB 49%, medical and lifestyle care 19% (OR 4·8, 95% CI 1·9–11·7)
Schauer et al³⁴ and Kashyap et al⁷¹	RYGB vs VSG vs intensive medical care	150 adults with type 2 diabetes	27–43	1 year	HbA_1c <6·0% (42 mmol/mol): RYGB 42%, VSG 37%^‡, medical care 12%
Mingrone et al³³	RYGB vs BPD vs conventional medical care	60 adults with type 2 diabetes	≥35	2 years	HbA_1c <6·5% (48 mmol/mol) without diabetes drugs: RYGB 75% (OR 7·5, 95% CI 2·0–28·6, vs medical care), BPD 95% (OR 9·5, 95% CI 2·5–35·5, vs medical care), medical care 0%
Dixon et al³⁵	LAGB vs conventional medical care	60 adults with type 2 diabetes	30–40	2 years	HbA_1c <6·2% (44 mmol/mol) without diabetes drugs: LAGB 73%, medical care 13% (OR 5·5, 95% CI 2·2–14·0)^§
O’Brien et al³⁶	LAGB vs supervised lifestyle intervention	50 adolescents without type 2 diabetes	>35	2 years	>50% excess bodyweight loss: LAGB 84%, lifestyle intervention 12%

BPD= biliopancreatic diversion. LAGB= laparoscopic adjustable gastric banding. OR=odds ratio. RYGB=Roux-en-Y gastric bypass. VSG=vertical sleeve gastrectomy.

All comparisons of surgical vs non-surgical interventions are significantly different (p<0·05). All surgical interventions also produced significantly more weight loss than did their respective non-surgical controls (p<0·05).

^†

Defined as HbA_1c <7·0% (53 mmol/mol), LDL cholesterol <100 mg/dL (2·59 mmol/L), and systolic blood pressure <130 mm Hg at 1 year. The benefit of surgery on this triple endpoint was primarily driven by reductions in HbA_1c. The RYGB group also used 66% fewer drugs for diabetes, hypertension, and dyslipidaemia at 1 year than did the medical and lifestyle care group (p<0·001).

^‡

Fewer diabetes drugs, including insulin, were being used at 1 year in the RYGB group compared with the VSG group.

^§

All participants had mild diabetes (mean HbA_1c at baseline 7·7%, 61 mmol/mol) of less than 2 years’ duration.