Bariatric surgery procedures successfully used to treat diabetes
CHICAGO—Bariatric surgery procedures reduced obese patients' hemoglobin A1c levels more effectively than medical therapy and were associated with no life-threatening complications, reported a study presented at the annual meeting of the American College of Cardiology last week.
CHICAGO—Bariatric surgery procedures reduced obese patients' hemoglobin A1c (HbA1c) levels more effectively than medical therapy and were associated with no life-threatening complications, reported a study presented at the annual meeting of the American College of Cardiology last week.
The trial included 150 patients, age 20 to 60 years, who had a diagnosis of type 2 diabetes, an HbA1c above 7% and a BMI of 27 to 43 kg/m2. Their average HbA1c was 9.2%. They were randomized to one of three groups: intensive medical therapy alone, medical therapy plus Roux-en-Y gastric bypass or medical therapy plus sleeve gastrectomy.
The study was presented at the ACC meeting and was published online by the New England Journal of Medicine on March 26.
The primary endpoint of the study was an HbA1c of 6% or lower. After a year of follow-up, 12% of patients in the medication group had achieved that goal, compared to 42% who underwent bypass and 37% who underwent sleeve gastrectomy. The bypass arm also had the lowest mean HbA1c: 6.4% versus 6.6% and 7.5% in the sleeve and medication alone groups, respectively. The surgery groups lost significantly more weight than the medical group (25 to 30 kg vs. 5 kg) and reduced their use of antihyperglycemic medications.
“All of the gastric bypass patients that reached the target did so without any medication. That's as close to a definition of remission as you can get,” said lead study author Philip R. Schauer, MD.
Four patients had to undergo reoperation, but none died or suffered life-threatening complications. Further follow-up is necessary, but based on these results, bariatric surgery “represents a potentially useful strategy for management of uncontrolled diabetes,” the study authors concluded. They noted that gastric bypass showed better results than sleeve gastrectomy on the study's various outcomes, but that the differences were not significant and the study wasn't powered to detect a difference between those groups.
—By Stacey Butterfield, Associate Editor