A study published in today’s New England Journal of Medicine (NEJM) shows that bariatric surgery together with medical therapy cut a patient’s blood glucose levels more than medical therapy alone in obese patients who also have type 2 diabetes.
The Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, conducted at the Cleveland Clinic from 2007 to 2011, compared intensive medical therapy with gastric bypass or sleeve gastrectomy as methods of improving glycemic control in Type 2 diabetes patients. Researchers pointed out that many surgical patients, especially those that received gastric-bypass, were later able to control their diabetes without medications.
Moderately obese subjects (those with a body mass index, or BMI, of 30 to 35 ) who underwent both surgery and medical therapy achieved a concentrated plasma glucose, or A1C level of 6.0% or less 12 months after starting the study. This level is considered within the “normal” range for blood glucose for diabetics, according to the American Diabetes Association (ADA) guidelines. Study patients were between 20 and 63 years old, had BMIs of 27 to 43, and had not previously undergone bariatric surgery. Medical therapy included lifestyle counseling, weight management, frequent home glucose monitoring, and the use of some of the latest drug therapies such as long acting insulin, a new class of diabetes drugs called incretin mimetics GLP-1 analogues.
Investigators concluded that:
bariatric surgery represents a potentially useful strategy for management of uncontrolled diabetes, since it has been shown to eliminate the need for diabetes medications in some patients and to markedly reduce the need for drug treatment in others. In addition, among patients undergoing surgery, cardiovascular risk factors improved, allowing reductions in lipid-lowering and antihypertensive therapies
The incidence of obesity and of type 2 diabetes has surged in the past several decades, and both are serious threats to global public health. According to the International Diabetes Federation, 366 million people around the globe had diabetes in 2011, and they project that over 523 million will suffer from this disease by 2030. Another 183 million people go undiagnosed. Additionally, the World Health Organization says that the obesity rate worldwide has more than doubled since 1980 – in 2008, 1.5 billion adults, over age 20 were overweight, and of these, 500 million were considered obese. By 2010, 43 million of the world’s children were suffering from preventable obesity. Both obesity and diabetes lead to other serious conditions such as heart disease, circulatory problems, stroke, and premature death.