Bariatric Surgery Bests Medical Therapy for Diabetes

A new study shows bariatric surgery is a highly effective and durable treatment for diabetes mellitus type 2 (DM2) in obese patients, enabling nearly all surgical patients to be free of insulin three years after surgery.

Researchers at the Cleveland Clinic (OH, USA) assessed outcomes three years after the randomization of 150 obese patients with uncontrolled DM2 to receive either intensive medical therapy alone (50 participants), intensive medical therapy plus Roux-en-Y gastric bypass (50 participants), or intensive medical therapy plus sleeve gastrectomy (50 participants). The primary end point was a hemoglobin A1c (HbA1c) level of less than or equal to 6%.

The results showed that at the three-year mark, more patients in the gastric bypass group (37.5%) achieved blood sugar control without the use of any diabetic medications compared with those that received intensive medical therapy alone (5%), or in those in the sleeve gastrectomy group (24.5%). The study also revealed significant improvements in five of eight mental and physical domains for patients in the gastric bypass group, and two of eight domains for the patients in the sleeve gastrectomy group; there was no improvement in the medical therapy group. The study was published on May 22, 2014, in the New England Journal of Medicine (NEJM).

"We looked at quality of life, because ultimately it is all about helping our patients live a healthier, happier life,” said lead author Philip Schauer, MD, director of the Cleveland Clinic Bariatric and Metabolic Institute. “When compared to sleeve gastrectomy and medical therapy, gastric bypass patients achieved greater weight loss, were on fewer medications, had a higher success rate in controlling their diabetes, and an improved quality of life."

“We see patients whose lives are ravaged by diabetes,” added study author endocrinologist Sangeeta Kashyap, MD. “More than 90% of the patients who underwent bariatric surgery were able to lose 25% of their body weight and control their diabetes without the use of insulin and multiple diabetes drugs.”

DM2 is a metabolic disorder that is characterized by hyperglycemia in the context of insulin resistance and relative lack of insulin. This is in contrast to diabetes mellitus type 1, in which there is an absolute lack of insulin due to breakdown of islet cells in the pancreas. The classic symptoms are excess thirst, frequent urination, and constant hunger. DM2 makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.

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