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Bariatric Surgery Versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes
Study Questions:
What are long-term outcomes of bariatric surgery in patients with uncontrolled type 2 diabetes mellitus, compared to those receiving intensive medical therapy alone?
Methods:
This was an analysis of outcomes 3 years after randomization of 150 obese patients with uncontrolled type 2 diabetes mellitus in the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Effectively) trial. Patients received either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin of 6.0% or less, with or without the use of diabetes medications.
Results:
The target glycated hemoglobin level of 6.0% or less was achieved in 5% of the patients in the medical-therapy group, as compared with 38% of those in the gastric bypass group (p < 0.001) and 24% of those in the sleeve-gastrectomy group (p = 0.01). Secondary endpoints of body mass index (BMI), body weight, waist circumference, measures of quality of life, and levels of triglycerides and high-density lipoprotein cholesterol also showed more favorable improvement in the surgical groups, compared to the group receiving medical therapy alone.
Conclusions:
The authors concluded that in obese patients with uncontrolled type 2 diabetes mellitus, those who receive bariatric surgery and intensive medical therapy, compared to those receiving medical therapy alone, have improved glycemic control at 3 years.
Perspective:
The authors provide convincing evidence about the durability of bariatric surgery in obese patients with uncontrolled type 2 diabetes mellitus. Of note, 36% of patients in the present trial had a BMI of 27-34 kg/m2; these patients had an improvement in glycemic control that was similar to that in patients with a BMI exceeding 35 kg/m2. Such results may suggest that the benefits of bariatric surgery in those patients with uncontrolled type 2 diabetes mellitus may not necessarily meet conventional eligibility criteria for such surgery. Although results from this analysis are promising, larger scale trials are necessary to establish whether bariatric surgery reduces morbidity and mortality in obese diabetic persons.
Keywords: Bariatric Surgery, Gastric Bypass, Diabetes Mellitus, Type 2, Glycated Hemoglobin A, Cholesterol, Waist Circumference, Body Mass Index, Gastrectomy, Quality of Life, Obesity, Morbid, Gastroplasty, Lipoproteins, HDL, Triglycerides
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