In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery yielded greater glycemic control than medical therapy alone, according to a study in the New England Journal of Medicine.1
Philip Schauer, MD, of the Bariatric and Metabolic Institute at the Cleveland Clinic, conducted a randomized, nonblinded, single-center study of 150 obese patients with uncontrolled type 2 diabetes. Mean patient age was 49 ±8 years, and 66% of the participants were women. The average glycated hemoglobin level was 9.2±1.5%. Participants were assigned to undergo intensive medical therapy alone or intensive medical therapy plus either Roux-en-Y gastric bypass or sleeve gastrectomy. The primary endpoint was the proportion of patients with a glycated hemoglobin level of 6.0% or less 12 months after treatment.
Of the 150 patients, 93% completed 12 months of follow-up. The proportion of patients who achieved the primary endpoint was 12% (5 of 41 patients) in the medical therapy group, 42% (21 of 50 patients) in the bariatric surgery group (P = .002), and 37% (18 of 49 patients) in the sleeve gastrectomy group (P = .008). Glycemic control improved in all three groups, with a mean glycated hemoglobin level of 7.5 ±1.8% in the medical therapy group, 6.4 ±0.9% in the gastric-bypass group (P < .001), and 6.6 ±1.0% in the sleeve gastrectomy group (P = .003). Weight loss was greater in the gastric bypass group and sleeve gastrectomy group than in the medical therapy group. The use of drugs to lower glucose, lipid, and blood pressure levels decreased significantly after both surgical procedures but increased in patients who received medical therapy only. The index for homeostasis model assessment of insulin resistance improved significantly after bariatric surgery. Four patients underwent reoperation, and no deaths or life-threatening complications occurred.
“Despite [study] limitations, we conclude that bariatric surgery represents a potentially useful strategy for management of uncontrolled diabetes, since it has been shown to eliminate the need for diabetes medications in some patients and to markedly reduce the need for drug treatment in others,” the researchers concluded.
- Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes [published online ahead of print March 26, 2012]. New Engl J Med. doi:10.1056/NEJMoa1200225.
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