A.MOH1, S.LOW1, E.YEOH2, C.H.TAN1, B.LAM1, S.TAVINTHARAN2, C.F.SUM2, S.C.LIM2, A.CHENG1
Khoo Teck Puat Hospital1, Admiralty Medical Centre2
Evidence from randomized clinical trials (RCT) supporting surgical superiority in treating type 2 diabetes (T2D) among patients with mild obesity is currently limited, particularly in Asian populations. This 5-year single-centre, open-label RCT compared Roux-en-Y gastric bypass (RYGB) versus best medical treatment on glycaemia, weight control and potential costs in multi-ethnic Asians with mild obesity and T2D.
Participants with T2D and body mass index (BMI) 27–32 kg/m² were randomized to RYGB or best medical treatment utilising novel anti-diabetic medications with weight-loss benefits [e.g glucagon-like peptide 1 receptor agonist (GLP1RA) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)]. Diabetes remission was defined as HbA1c≤6% and no glucose-lowering medication at 12 months post-treatment and beyond. Percentage changes in glycaemic and weight parameters, and direct treatment costs were assessed.
The final cohort involved 26 subjects (14 medical, 12 RYGB; age:44±10 years, 34.6% males, BMI:29.4±1.6 kg/m²). At 12 months post-surgery, 50% of the RYGB patients achieved diabetes remission and 83% discontinued all anti-diabetic medications. By year 5, 42% remained in remission. In contrast, none in the medical group (93% on GLP1RA/SGLT2i) reached diabetes remission. Percentage declines in fasting plasma glucose, HbA1c and BMI were significantly greater in the RYGB arm (P=0.022, P=0.011 and P<0.001, respectively). The cumulative expenditure of the medical arm exceeded that of RYGB at 12 months, largely due to the costly newer medications.
RYGB is superior to best medical treatment in achieving long-term glycaemic and weight benefits in Asians with T2D and class I obesity, and is cost saving.