Roux-en-Y helps patients meet diabetes treatment goals.

SAN FRANCISCO -- Roux-en-Y gastric bypass surgery is effective in helping people with type 2 diabetes meet the American Diabetes Association goals for hemoglobin [A.sub.1c], systolic blood pressure, and LDL cholesterol, according to a retrospective study presented at the annual meeting of the Endocrine Society.

Dr. Daniel Leslie of the University of Minnesota, Minneapolis, said that his study was the first to report on the effectiveness of Roux-en-Y in meeting treatment goals set by the American Diabetes Association (ADA) in 2004 for the management of type 2 diabetes.

Dr. Leslie and colleagues reviewed all Roux-en-Y gastric bypass procedures conducted at the University of Minnesota between 2001 and 2007. Of all the procedures, 85% were done laparoscopically. There were a total of 2,210 consecutive surgeries, and of those patients, 564 had type 2 diabetes.

But only 338 patients had all three measures--[HbA.sub.1c], systolic blood pressure, and LDL cholesterol--available at baseline. Only 169 patients had all three measures available both preoperatively and postoperatively, Dr. Leslie said.

The average age of the patients was 51 years; 79% (133) were women and 85% (143) were white. The average duration of diabetes was 9 years, although 39% (66) of the group had diabetes for more than 10 years. Patients were followed for an average of 26 months.

Dr. Leslie estimated that 32% (54) of the patients met the ADA goals after surgery. Only 9.5% (16) of patients had met those goals before gastric bypass. The duration of diabetes was not associated with meeting the goals.

The ADA goals included an [HbA.sub.1c] of 7% or less, LDL cholesterol of 100 mg/dL or less, and systolic blood pressure of 130 mm Hg or less.

The [HbA.sub.1c] value improved from 7.7% on average to 6.2% after the procedure. Systolic blood pressure dropped from an average of 136 mm Hg to 128 mm Hg. The use of oral antidiabetic medications and insulin dropped dramatically, Dr. Leslie noted.

Use of cholesterol-lowering and blood pressure-lowering drugs also fell, but the need for antihypertensives increased after about 24 months--a finding seen in other studies, Dr. Leslie said.

The mean body mass index dropped from 49 to 33 kg/[m.sup.2] after the surgery.

"Gastric bypass is a useful tool for improving diabetes treatment goals," said Dr. Leslie, although he noted that the study was not controlled.

Dr. Leslie disclosed that his surgery division receives grant support from Covidien AG and Ethicon Endo-Surgery Inc., but said that he does not personally receive any industry grants.

BY ALICIA AULT

Associate Editor, Practice Trends