Bariatric Surgery Best for Obese Diabetics

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PHILADELPHIA—Bariatric surgery improves glycemic control better than optimal medical therapy alone for obese patients with type 2 diabetes, two randomized trials determined.

Hemoglobin A1c levels normalized to under 6 percent by 1 year for 42 percent of patients who got gastric bypass surgery and 37 percent who got sleeve gastrectomy compared with 12percent  on intensive medical therapy alone (P=0.002 and P=0.008), Philip R. Schauer, MD, of the Cleveland Clinic, and colleagues reported in the STAMPEDE trial.

After 2 years in a second trial, diabetes went into remission with fasting glucose under 100 mg/dL and A1c under 6.5 percent off medication in 75 percent of gastric bypass patients and 95 percent of biliopancreatic diversion patients compared with none on conventional medical therapy.

Metabolic control also improved more in the surgery groups of both trials, appearing online in the New England Journal of Medicine.

"Although type 2 diabetes has been the domain of physicians, surgeons may now be able to claim greater success in achieving improved metabolic control," an accompanying editorial suggested, calling the results likely practice changing.

Longer term and larger studies are needed to prove a durable benefit and whether the results would be as good in routine practice, noted editorialists Paul Zimmet, MD, PhD, of the Baker IDI Heart and Diabetes Institute, Melbourne, Australia, and K. George M.M. Alberti, DPhil, of King's College Hospital in London.

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

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