In Reply We, too, were puzzled by the lack of remission of type 2 diabetes (T2DM) in the lifestyle intervention–alone group despite a standardized program delivered by experienced interventionists that resulted in comparable weight loss and similar magnitudes of improvement in lipids and blood pressure levels as in the Look AHEAD (Action for Health in Diabetes) study. We do point this out in the discussion of the 1-year results of our trial.1 We hypothesized then that this lack of T2DM remission in the lifestyle intervention–only group may have to do with the relatively small sample size, along with the variability in treatment response, T2DM severity differences that were not measured by hemoglobin A1c level or disease duration, differences between treatment groups in adjustments of medication that were performed by nonstudy (and thus different) treating physicians, and other unmeasured factors. Furthermore, it is important to point out that, in this trial, the definition of either partial or complete T2DM remission required the absence of any antidiabetic medications. In other similar surgical vs medical treatment trials that have recently been reported, such as the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently)2,3 and Why WAIT (Weight Achievement and Intensive Treatment)4 trials, the nonsurgical treatment arm consisted of an intensive medical treatment algorithm, along with lifestyle education, and the primary end points did not require the absence of medications, so the results between these trials and our trial are not directly comparable with respect to rates of remission.
Courcoulas AP, Jakicic JM. Mass Treatment With Bariatric Surgery for Type 2 Diabetes Mellitus—Reply. JAMA Surg. 2016;151(2):197. doi:10.1001/jamasurg.2015.3408