Bariatric Surgery Benefits Patients with Type 2 Diabetes

Patients with type 2 diabetes benefit more from bariatric surgery than from optimal medical therapy alone, a new trial found. 

For 42% of patients who were given gastric bypass surgery, hemoglobin A1c levels normalized to under 6% by year 1, reported Philip R. Schauer, MD, of the Cleveland Clinic, and colleagues.  Improvement was also reported in 37% of patients given sleeve gastrectomy, compared with only 12% on intensive medical therapy alone. 

The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, presented at the American College of Cardiology meeting in Chicago, included 150 obese patients with a body mass index of 27 to 43 kg/m2 and diabetes with hemoglobin A1c over 7.0%.  Patients were randomized to Roux-en-Y surgery, sleeve gastrectomy or medical therapy alone. 

All patients were given intensive medical therapy in accordance with the American Diabetes Association guidelines, including lifestyle counseling, weight management, and newer diabetes drugs. 

After 1 year, gastric bypass had cut weight and BMI significantly more than sleeve gastrectomy.  Metabolic syndrome and insulin resistance also improved more with bariatric procedures. 

In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone,” researchers concluded. “Further study will be necessary to assess the durability of these results.” 

-Michael Potts

References

Schauer P, Kashyap S, Wolski K, et al. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes [published online ahead of print, March 26, 2012].  NEJM 2012; DOI: 10.1056/NEJMoa1200225