Curing type 2 diabetes in obese people has been a complex medical challenge for clinicians all over the world, as weight loss surgery and medications continue to battle for the best diabetes treatment title. Now in a new study, a group of researchers took on the longest-term study ever performed to determine which of the above-mentioned interventions is better.

Previous studies have shown that weight loss surgery is more effective in controlling type 2 diabetes compared to the usual diabetes treatment in the short term. However, these randomized controlled researches have short follow-up and thus were not able to present with long-term outcomes. In the new study, a group of scientists from the King's College London and the Catholic University of the Sacred Heart in Italy, embarked on a five-year study to find out the difference between the effects of conventional medical treatment and weight loss surgery in the long term.

The researchers performed the study by randomly assigning a treatment option to 60 patients aged 30-60 years old with a history of type 2 diabetes that persisted for at least five years. Twenty study subjects were assigned to each treatment procedure, which includes medication, gastric bypass and biliopancreatic diversion. Gastric bypass is the surgical re-routing of food passage in the stomach and small intestines so limited calorie absorption may take place. Biliopancreatic diversion is surgical procedure that involves decreasing the size of the stomach to minimize food intake. The researchers then analyzed the participants' cardiovascular risk, metabolic control, drug utilization, overall quality of life and presence of complications after five years.

The findings of the study, published in the journal The Lancet, showed that 50 percent of surgical patients (both in the gastric bypass and biliopancreatic diversion groups) remained diabetes-free at the fifth year of the study. The medical treatment group, on the other hand, had no single patient, who was able to maintained remission. Although weight modifications did not ascertain diabetes remission or relapse post-operatively, the researchers were able to note that the participants who underwent surgery lost more weight than the medically treated subjects. Upon assessing cardiovascular risk, drug utilization and levels of plasma lipids, the surgical patients exhibited good outcomes. Lastly, the scientists were able to observe that 27 percent of the medically treated patients developed five major complications compared to only one among the gastric bypass group and none in the biliopancreatic diversion group.

"What really is causing the remission of diabetes after surgery remains mysterious," says Dr. Francesco Rubino, one of the study authors from the King's College London. All experts know is that the intestines secrete hormones that regulate metabolic processes. With this, altering the gastrointestinal tract in such a way that food bypasses the stomach and small intestine may contribute to the restoration of correct metabolic control.

In the end, the researchers concluded that surgery is more effective than administration of medications in controlling obese individuals diagnosed with type 2 diabetes. Nonetheless, they advised that persistent monitoring of blood sugar levels must be performed to prevent the possible recurrence of hyperglycemia or increased blood sugar.

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