Bariatric Surgery Improves Diabetes Outcomes at 3 Years

The addition of bariatric surgery to intensive medical therapy improves glycemic control and other 3-year outcomes for obese patients with type 2 diabetes, reports a trial in the New England Journal of Medicine.

In the STAMPEDE trial, 150 obese patients with uncontrolled type 2 diabetes were randomly assigned to intensive medical therapy alone or with bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). The mean age was 48 years; more than two thirds of the patients were women. At baseline, the patients had a mean body mass index of 36 and a mean glycated hemoglobin of 9.3 percent. At 3 years, the rates of glycemic control (glycated hemoglobin 6.0 percent or less) were evaluable in 137 patients.

The target glycated hemoglobin level was achieved by 5 percent of patients receiving medical therapy only versus 38 percent of those receiving medical therapy plus bariatric surgery. The patients in the surgery group were also using less insulin and other glucose-lowering agents.

The patients undergoing bariatric surgery also had greater weight loss: 24.5 percent with gastric bypass and 21.1 percent with sleeve gastrectomy, compared with 4.2 percent with medical therapy. The surgery group had better quality-of-life scores and no late surgical complications.

Previous studies with 1- to 2-year follow-up have reported improved outcomes with bariatric surgery in patients with type 2 diabetes. The new trial shows improved glycemic control and other outcomes 3 years after bariatric surgery, compared with intensive medical therapy only.

“Some patients in our study had complete diabetes remission, whereas others had a marked reduction in the need for pharmacologic treatment,” the researchers write. They also note sustained reduction in cardiovascular risk factors after bariatric surgery [Schauer PR, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med March 31, 2014. doi: 10.1056/NEJMoa1401329].