Surgery Helps Control Type 2 Diabetes for Years
Bariatric surgery has the potential to improve the quality of life for obese patients with type 2 diabetes over the long-term, says a newly published study by Cleveland Clinic researchers.
Bariatric surgery has the potential to improve life for obese patients with type 2 diabetes over the long term, says a new study by Cleveland Clinic researchers.
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The study shows that even years later, the surgery helps patients control the disease and greatly reduces their dependence on medications. The study is published today in The New England Journal of Medicine,
Cleveland Clinic researchers studied 150 obese patients with type 2 diabetes. All the patients received medicine to control their condition.
Fifty patients underwent gastric bypass surgery and 50 underwent sleeve gastrectomy. These types of minimally invasive procedures reduce stomach size and, in the case of gastric bypass, bypass part of the intestines. These procedures reduce appetite and enhance satiety, resulting in weight loss by reducing calorie intake.
The third group took medicine and received intensive counseling.
After three years, 90 percent to 95 percent of the patients who had bariatric surgery no longer needed to take insulin. And many were able to stop taking medicines for their diabetes.
About 55 percent of the patients in the non-surgery group needed to continue taking insulin.
Thirty-five percent of patients who had surgery achieved a three- year remission of diabetes or much improved blood sugar control. None of medicine-only patients achieved remission. Their improvement in blood sugar was much less than the patients who had bariatric surgery.
The patients who had bariatric surgery also saw less need for medicine to control their blood pressure and cholesterol.
These patients also saw weight loss five to six times greater on average compared with those in the medicine-only group. Obesity is the main trigger for type 2 diabetes.
“This study shows that bariatric surgery is more effective with persistent benefits up to three years for treating type 2 diabetes in moderate and severely obese patients when compared with medical therapy,” says Sangeeta Kashyap, MD, one of the study’s lead investigators.
“Weight loss in patients with shorter duration of diabetes was the primary driver for remission after surgery,” Dr. Kashyap says.
Dr. Kashyap is one of the study’s lead investigators and an endocrinologist at Cleveland Clinic’s Endocrinology & Metabolism Institute.
Patients in the study also completed forms that asked about their quality of life.
Patients in the gastric bypass group reported significant improvements in five of eight mental and physical areas. Patients in the sleeve gastrectomy group reported improvement in two of eight areas. There was no improvement in the medical therapy group.
“The three-year data confirm that bariatric surgery maintains its superiority over medical therapy for treating type 2 diabetes in severely and mildly obese patients,” says lead investigator Philip Schauer, MD.
Dr. Schauer is Director of Cleveland Clinic’s Bariatric and Metabolic Institute.
The researchers said further research is necessary to continue to advance the study of bariatric surgery as a treatment option for patients with diabetes.
The study is the largest randomized trial of its type. The study also is one of the longest that compares medical therapy to bariatric surgery.
Researchers will present results of the study today at the Annual Scientific Session of the American College of Cardiology in Washington, D.C.
The study’s name is the STAMPEDE trial. STAMPEDE stands for Surgical Treatment And Medications Potentially Eradicate Diabetes Efficiently.