Is Bariatric Surgery the Answer for Diabetes?

When compared with medical therapy, bariatric weight-loss surgery is an effective, lasting treatment for type 2 diabetes in obese patients, according to a new study.

Cleveland Clinic researchers conducted a study in which they enrolled 150 patients with poorly controlled diabetes, and randomized them equally to receive 1 of 3 treatments: intensive medical therapy only, gastric bypass, or gastrectomy. After 3 years, 37.5 percent of patients in the gastric bypass group were controlling blood sugar without the use of diabetic medications, compared to 24.5 percent in the gastrectomy group, and 5 percent in the medical therapy group. In addition, the average weight loss seen in the bariatric surgery groups was 5 to 6 times greater than for the medical therapy group.

Relying on information from questionnaires completed by patients at the start and end of the 3-year period, the researchers also found significant quality of life improvements in the 2 surgery groups, and none in the medical therapy group. Patients in the gastric bypass group saw improvement in 5 of 8 areas of mental and physical quality of life, while patients in the gastrectomy group experienced improvement in 2 of the 8 areas.
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The data confirm that bariatric surgery “maintains its superiority over medical therapy for the treatment of type 2 diabetes in severely obese patients,” and show that “bariatric surgery is just as effective in treating mildly obese patients with type 2 diabetes,” according to the study authors.

Primary care physicians “should discuss bariatric surgery with their patients that are obese and not in good control of their diabetes with optimal medications,” says Philip Schauer, MD, director of the Bariatric and Metabolic Institute at the Cleveland Clinic, and co-author of the study.

“[Primary care practitioners] should not only consider those who are morbidly obese,” adds Schauer, “as our study shows that surgery can also have a significant benefit for those who are overweight or only mildly obese.”

In addition to blood control, it’s important to remember that surgery can provide a reduction in cardiovascular risk factors as well, he adds, noting that “our surgical patients were also happier after surgery, showing a large increase in quality of life scores not seen in those patients on medication alone.”

—Mark McGraw

Reference

 Schauer P, Bhatt D, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes. NEJM. 2014. DOI: 10.1056/NEJMoa1401329