All patients got intensive medical therapy according to American Diabetes Association guidelines with lifestyle counseling, weight management (recommended to include Weight Watchers), and newer diabetes drugs, such as the incretin analogues. Glycosylated hemoglobin levels fell rapidly in the first 3 months after surgery. By 1 year, they reached a mean 6.4% after gastric bypass and 6.6% after sleeve gastrectomy compared with 7.5% with medical therapy alone (P<0.001 and P=0.003). For the primary endpoint of a glycosylated hemoglobin under 6.0% at 1 year, the two bariatric surgery groups came up equal (P=0.59), though all who achieved that target in the gastric bypass group did so off diabetes medications versus 28% in the sleeve gastrectomy group. Not surprisingly, weight loss after gastric bypass and sleeve gastrectomy exceeded that of medical therapy alone over 1 year (-64.8 and -55.3 lb versus -11.9 lb, both P<0.001). Gastric bypass cut weight as well as BMI significantly more than sleeve gastrectomy (P=0.02 and 0.03, respectively). "Reductions in the use of diabetes medications occurred before achievement of maximal weight loss, which supports the concept that the mechanisms of improvement in diabetes involve physiologic effects in addition to weight loss, probably related to alterations in gut hormones," Shauer's group noted. Medication use to control glucose, lipids, and blood pressure fell significantly after both surgeries but increased with medical therapy alone. Metabolic syndrome and insulin resistance also improved more with the bariatric procedures. No patients died or had a life-threatening complication, though four patients required additional surgical interventions. The study wasn't powered to look for differences between the surgical arms or for clinical outcomes, though cardiovascular risk factors did improve. Limitations included the short follow-up and the open-label assessment of patients at a single center.