Weight loss is never easy but obesity is the big risk factor Type 2 Diabetes Mellitus, so clearly people who have it aren't likely to just diet and for that reason gastric band surgery has become more popular.

Yet it may not be necessary. A small pilot programl led by Joslin Diabetes Center and Brigham and Women's Hospital researchers found that an intensive group-based medical diabetes and weight management program achieved similar improvements in controlling blood sugar levels after one year. 

As reported in the Journal of Clinical Endocrinology&Metabolism, the SLIMM-T2D (Surgery or Lifestyle with Intensive Medical Management in Treatment of Type 2 Diabetes) trial enlisted 45 volunteers who had long-duration type 2 diabetes, struggled to manage their diabetes and had a body mass index (BMI) of 30 or higher. 

The study randomly divided the participants into two groups.

One group received an adjustable gastric band procedure, which inserts a band around the upper stomach whose tightness can be adjusted. Fullness signals them to stop eating.

The other group of participants underwent Joslin's Why WAIT (Weight Achievement and Intensive Treatment), a clinically available program built on behavioral interventions that have been proven to be effective.

After one year, the two groups achieved similar lowering of blood sugar levels--average levels of hemoglobin A1C (a standard measurement of blood sugar levels over several months) dropped by 1.2 for patients with the gastric band and by 1.0 for patients in the IMWM program. The groups also saw similar-magnitude improvements in their levels of blood sugar when fasting, another standard metric for type 2 diabetes management.

Weight loss was similar between the two arms at three months. At one year, however, the participants given the band achieved greater average loss (30 pounds compared to 19 pounds) and were continuing to lose weight. The Why WAIT group saw greater reductions in blood pressure than the band group, but other measures of cardiovascular health were generally comparable between the two groups.

Participants in both arms of the trial reported that their health had been improved on a number of measures and that they were enjoying better quality of life.

A previous SLIMM-T2D study led by Joslin and reported last year in the Journal of the American Medical Association compared the use of the most common gastric bypass surgery, called Roux-en-Y, to Why WAIT treatment. In that earlier trial, participants who underwent Roux-en-Y gastric bypass lost significantly more weight and achieved better diabetes control than those in the medical treatment arm of the trial.

 "We can anticipate long-term health benefits from both of these approaches, but they do require some investment of time and energy by the patient," says trial leader Allison Goldfine, M.D., head of Joslin's Section of Clinical Research and an Associate Professor of Medicine at Harvard Medical School.