Management of Type 2 Diabetes (T2D) is particularly challenging in patients also affected by obesity. The 5-year follow-up results of a randomized clinical trial found bariatric surgery plus intensive medical therapy more effective than intensive medical therapy alone in long-term glycemic control in overweight/obese patients with uncontrolled T2D.1

Investigators of the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial enrolled 150 patients who were diagnosed as overweight/obesity (BMI 27-43 kg/m2) and T2D (HbA1c > 7%). These patients were randomly assigned to either intensive medical therapy (IMT) alone or IMT plus bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). The primary outcome was to assess whether patients could achieve HbA1c of <6% with or without diabetes medications.

Compared with patients receiving only IMT, the surgically treated patients had better 5-year outcome and relied less on T2D medications:

  • 6% in the Roux-en-Y gastric bypass group, 23.4% in the sleeve gastrectomy group, and 5.3% in the IMT only group achieved HbA1c of < 6%

Patients undergoing bariatric surgery also performed better than those receiving only IMT across various secondary endpoints:

  • HbA1c showed mean reductions of 2.1% and 0.3% in the surgical  groups and IMT group, respectively
  • Fasting plasma glucose showed a median reduction of 72 mg/dL, 49 mg/dL, and 14 mg/dL in gastric bypass group, sleeve gastrectomy group, and IMT group, respectively
  • Body weight was reduced by a mean of 23.2 kg (51.1 lb), 18.6 kg (41.0 lb), and 5.3 kg (11.7 lb) in gastric bypass group, sleeve gastrectomy group, and IMT group, respectively

Patients in both surgical groups also experienced better improvement in serum HDL, serum triglycerides, and better quality-of-life measures.

The study results were published in the New England Journal of Medicine (February 2017).

Why is this clinically important?

The prevalence of T2D is increasing rapidly along with the obesity pandemic. According to the CDC, more than 29 million Americans have T2D.2 Diabetic complications such as cardiovascular disease, neuropathy, retinopathy, and nephropathy are debilitating and can be fatal.

Bariatric surgery is not only effective for weight loss, but has emerged as a valuable option for the treatment of T2D among obese patients; however data supporting the long-term benefits of bariatric surgery in diabetes management have been sparse. The 5-year data from this well-conducted trial provide favorable, and long term, evidence for the consideration of  bariatric surgery as an option for  durable glycemic control.

Click here to read the NEJM abstract

References

  1. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 5-Year Outcomes. N Engl J Med 2017;376:641-51.
  2. Diabetes Latest. Centers for Disease Control and Prevention. (Accessed March 31, 2017, at https://www.cdc.gov/features/diabetesfactsheet/)

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