Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes

Abstract

BACKGROUND In short-term randomized trials (duration, 1 to 2 years), bariatric surgery has been associated with improvement in type 2 diabetes mellitus. METHODS We assessed outcomes 3 years after the randomization of 150 obese patients with uncontrolled type 2 diabetes to receive either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary end point was a glycated hemoglobin level of 6.0% or less. RESULTS The mean (±SD) age of the patients at baseline was 48±8 years, 68% were women, the mean baseline glycated hemoglobin level was 9.3±1.5%, and the mean baseline body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.0±3.5. A total of 91% of the patients completed 36 months of follow-up. At 3 years, the criterion for the primary end point was met by 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). The use of glucose-lowering medications, including insulin, was lower in the surgical groups than in the medical-therapy group. Patients in the surgical groups had greater mean percentage reductions in weight from baseline, with reductions of 24.5±9.1% in the gastric-bypass group and 21.1±8.9% in the sleeve-gastrectomy group, as compared with a reduction of 4.2±8.3% in the medical-therapy group (P<0.001 for both comparisons). Quality-of-life measures were significantly better in the two surgical groups than in the medical-therapy group. There were no major late surgical complications. CONCLUSIONS Among obese patients with uncontrolled type 2 diabetes, 3 years of intensive medical therapy plus bariatric surgery resulted in glycemic control in significantly more patients than did medical therapy alone. Analyses of secondary end points, including body weight, use of glucose-lowering medications, and quality of life, also showed favorable results at 3 years in the surgical groups, as compared with the group receiving medical therapy alone. (Funded by Ethicon and others; STAMPEDE ClinicalTrials.gov number, NCT00432809.)

Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study

“…It achieves substantial and sustained weight loss, co-morbidity resolution, and improvements in quality of life and is associated with extended lifespan [3][4][5]. A systematic review has indicated that it is cost effective [6,7].…”

Surgery in the treatment of type 2 diabetes mellitus

“…Schauer et al (28,29) in a single-center RCT included 150 patients with T2DM and BMI 27-43 kg/ m 2 into intensive medical therapy alone or intensive medical therapy plus either RyGB or sleeve gastrectomy (SG) group. The number of patients was equally distributed between the treatment arms.…”

“…Schauer and colleagues (28,29,42) explored an effect of RyGB and SG on the treatment of T2DM (primary outcome was HbA1c <6.0%, with or without diabetes medications) among patients with BMI 27-43 kg/m 2 , as part of their RCT comparing surgery versus best medical treatment. A total of 50 patients were included in each group.…”

Modern Obesity Pharmacotherapy: Weighing Cardiovascular Risk and Benefit

“…22 Among patients with DM, bariatric surgery reduced glycated hemoglobin (HbA 1c ) level and number of DM medications at 3-year follow-up in the recent Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial. 23 Other risk factors also improve with weight loss. Weight loss due to lifestyle change, 24 Orlistat, 22 or bariatric surgery 25 reduces systolic blood pressure (SBP).…”

“…Bariatric surgery increased highdensity lipoprotein cholesterol (HDL-C) levels, decreased triglyceride levels, and had no effect on low-density lipoprotein cholesterol (LDL-C) levels in the STAMPEDE trial. 23 In one nonrandomized study, women who lost weight after completing a calorie-restriction protocol were found to have decreased C-reactive protein. 26 This strong relationship between weight and prognosis has been called into question for high-risk patients by 2 observations.…”