Surgery better for diabetes in the obese: studies

CHICAGO — Two clinical studies suggest that gastric surgery is better than traditional methods of care when it comes to controlling diabetes in overweight and obese patients.

The first study, coined STAMPEDE, and presented at the American College of Cardiology conference, showed that patients who had operations fared three to four times better than those who did not after one year.

The study followed 150 patients who were randomly assigned to surgery or regular medical care, including drug regimens. Their starting body mass indexes ranged from 27, or overweight, to obese at up to 42 BMI.

Those who got surgery saw significant improvements in blood sugar, or glycemic control, and were able to cut down on the number of medications they took, while those in the medical group tended to take more drugs than before with less effect.

Forty-two percent of people who had a laparoscopic gastric bypass and nearly 37 percent who had a sleeve gastrectomy achieved a lowering of blood sugar known as glycemic control, or a hemoglobin HbA1c level of six percent.

Only 12 percent of patients who received medical therapy, including counseling for lifestyle changes, achieved this level, which is slightly more aggressive than the seven percent or less HbA1c recommended by the American Diabetes Association.

Weight loss was five times greater for patients who received gastric bypass or sleeve gastrectomy compared with medical therapy (roughly 55 to 64 pounds compared to 12 pounds).

"Even though patients were given very intensive treatment, including new drugs, the surgical therapies were still superior," said lead investigator Philip Schauer, professor of surgery, director of the Bariatric and Metabolic Institute, Cleveland Clinic.

"For about a century, we have been treating diabetes with pills and injections," he added.

"And this is one of the first studies to show that surgical therapy may, at least in some patients, be much more effective than the polypharmacy approach to treating this disease."

The second study based in Rome, Italy, enrolled 60 people age 30-60 with a body mass index of 35 or higher and a history of type 2 diabetes. They were randomly assigned to one of two types or surgery, or intensive medical counseling.

After two years, the study found that "bariatric surgery resulted in better glucose control than did medical therapy."

Fifteen of the 20 patients who had surgery saw their diabetes go into remission, a situation none in the medical therapy group experienced, and weight loss in the surgery group was also far greater.

Gastric bypass surgery is a two-step operation that reduces the stomach to the size of a golf ball and then connects this smaller pouch to the intestines.

A gastric sleeve operation involves removing part of the stomach to reduce its volume by up to 80 percent.

Both surgeries carried more risks than encountered by patients on the medical therapy program, and a small number of patients experienced non-life threatening complications that had to be addressed through further surgery.

More research is needed to measure the long-term benefits of gastric bypass and stomach-reduction surgeries in managing diabetes.

Some 23 million American adults have type 2 diabetes, and about 80 percent of them are overweight or obese, according to US health figures.

The two studies are also detailed in the current issue of the New England Journal of Medicine.

An accompanying editorial in the journal said the studies "are likely to have a major effect on future diabetes treatment," but urged more research to determine what may lead to success and how long remission might last.

"Meanwhile, the success of various types of bariatric surgery suggests that they should not be seen as a last resort. Such procedures might well be considered earlier in the treatment of obese patients with type 2 diabetes."