Study: Bariatric Surgery Improves Glycemic Control in Patients with Diabetes
According to a new study, bariatric surgery and intensive medical therapy was more effective at long-term improvement of glycemic indexes in patients with type 2 diabetes than medical therapy alone.
The study included 150 patients who had type 2 diabetes and a body mass index (BMI) of 27 to 43 kg/m2, and followed-up with participants for 5 years. Intensive medical therapy and Roux-en-Y gastric bypass surgery was randomly assigned to 49 participants, intensive medical therapy and sleeve-gastrectomy was assigned to 47 participants, and intensive medical therapy without surgery was assigned to 38 patients.
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The primary outcomes of the study were glycated hemoglobin levels of 6% or less with or without the use of diabetes medications.
At 5 years, 134 patients remained in the trial (66% women), the mean glycated hemoglobin level was 9.2±1.5%, the mean BMI was 37±3.5 kg/m2.
Of the 49 patients who underwent gastric bypass, 14 met the primary endpoint of a glycated hemoglobin level of 6% or less at year 5. Eleven of the 47 patients who underwent sleeve-gastrectomy had a glycated hemoglobin level of 6% or less, and only 2 of the 38 who received medical therapy alone met the primary endpoint after 5 years of treatment.
Researchers found that patients who underwent surgery had a greater mean percentage reduction from baseline in glycated hemoglobin level than those on medication alone.
“At 5 years, changes from baseline observed in the gastric-bypass and sleeve-gastrectomy groups were superior to the changes seen in the medical-therapy group with respect to body weight (−23%, −19%, and −5% in the gastric-bypass, sleeve-gastrectomy, and medical-therapy groups, respectively), triglyceride level (−40%, −29%, and −8%), high-density lipoprotein cholesterol level (32%, 30%, and 7%), use of insulin (−35%, −34%, and −13%), and quality-of-life measures (general health score increases of 17, 16, and 0.3; scores on the RAND 36-Item Health Survey ranged from 0 to 100, with higher scores indicating better health) (P<0.05 for all comparisons),” the researchers wrote.
Overall, their research suggested that gastric bypass surgery and sleeve-gastrectomy with intensive medical therapy improved glycemic control and quality of life in patients with type 2 diabetes.
—Melissa Weiss
Reference:
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes [published online February 16, 2017]. N Engl J Med. doi:10.1056/NEJMoa1600869.