An article appearing in The New England Journal of Medicine on March 26, 2012 reported on a study called the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial that was designed to compare bariatric surgery procedures with intensive medical therapy treatments in treating type 2 diabetes in obese patients. The article concluded that for obese patients with uncontrolled type 2 diabetes, bariatric surgery combined with medical therapy resulted in glycemic control in significantly more patients than for patients who received medical therapy alone over the study period of 12 months.
The study involved 218 patients at the Cleveland Clinic who were screened from March 2007 through January 2011. The patients were between the ages of 20 and 60 who had type 2 diabetes and a Body Mass Index between 27 and 43. Of the 218 patients, 150 either had intensive medical therapy or intensive medical therapy along with bariatric surgery (gastric bypass or sleeve gastrectomy).
The intensive medical therapy included lifestyle counseling, weight management, frequent home glucose monitoring, and drug therapies. Every 3 months for the first 12 months, the patients returned for study-related visits. All of the patients received lipid-lowering medications and antihypertensive medications. The main goal of the study was to determine the proportion of patients who would have a glycated hemoglobin level of 6% or less (a measurement relevant to determining the severity of their type 2 diabetes) after 12 months.
The study found that of the 41 patients in the medical therapy alone group, 5 achieved this target. Of the 50 in the gastric bypass group, 21 reached the target (all without medications). And 18 of the 49 patients in the sleeve-gastrectomy group reached the target (5 of the 18 required use of glucose-lowering drug(s)).
The mean levels of glycated hemoglobin and fasting plasma glucose were significantly lower in both bariatric surgery groups, with a large and rapid improvement in 3 months after the surgical procedures, which improvement was sustained at 12 months, compared to those in the intensive medical therapy alone group, who experienced a smaller and more gradual improvement (the patients on medical therapy alone had some attenuation over the final 6 months despite an increase in medications).
The average number of diabetes medications used in the two bariatric surgery groups decreased significantly while the diabetes medications increased in the medical therapy alone group. The use of insulin in the gastric bypass surgery group was reduced to 4% and was reduced to 8% in the sleeve-gastrectomy group but was at 38% for the medical therapy alone group at 12 months.
The reductions in body weight, body mass index, waist size, and waist-to-hip ratios were greater for the bariatric surgery groups than for the medical therapy alone group at 12 months. The percent of excess weight loss was 88% for the gastric bypass group and 81% for the sleeve gastrectomy group but only 13% for the medical therapy alone group. The two bariatric surgery groups had a significantly greater reduction in the prevalence of metabolic syndrome than for the medical therapy alone group.
The two bariatric surgery groups had marked increases in high-density lipoprotein cholesterol (HDL, which is the “good” cholesterol) when compared to the medical therapy alone group (the levels of LDL and total cholesterol did not differ significantly among the three groups).
The two bariatric surgery groups had a significant reduction in the number of hyperlipidemia medications used (from 86% to 27% for the gastric bypass group and from 78% to 39% for the sleeve gastrectomy group, compared to 92% for the medical therapy alone group). However, there was no significant differences in blood pressure values for the three groups, although there was a significant reduction in the number of hypertension medications for the two bariatric surgery groups at 12 months.
If you or a loved one are obese and have type 2 diabetes, it may benefit you to sit down with your medical providers to discuss this study’s results and to determine if you are a candidate for any of the therapies discussed in the study.
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