A Stampede Toward More Effective Treatment for Type 2 Diabetes

Bariatric surgeons have been extolling the virtues of weight loss surgery for some time now. However, it has taken some time to convince our colleagues in other medical specialties that this was in fact the case. The evidence to support that claim has expanded as researchers from the Cleveland Clinic have released the results of their clinical trial, entitled “Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently” and known by the acronym STAMPEDE, comparing treatment of type 2 diabetes mellitus with intensive medical therapy and bariatric surgery versus intensive medical therapy alone. The article, “Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 3 Year Outcomes” can be found in its entirety on the website for the New England Journal of Medicine.
The study, headed by Dr. Philip Schauer, followed 150 patients with type 2 diabetes over the course of three years, with the patients equally split into three groups. One group was treated with medication alone, one group received medication and a Laparoscopic Sleeve Gastrectomy, and the third group received medication and a Laparoscopic Roux-en-Y Gastric Bypass. The one year results of this study had previously been released, showing superiority of the surgical options to medical treatment alone, but questions had remained about whether these results wound continue over a longer period of time.
The main focus of the study was on how well patients were able to control their blood sugar. The results were quite profound, with the patients in the two surgical groups having far better blood sugar control than those in the medication only group. After 3 years, only 5% of the patient in the medication group had very good blood sugar control, compared to 38% of the Bypass patients and 24% of the Sleeve patients. The surgical patients lost significant amounts of weight, while the medical patients did not lose any weight. Additionally, the patients in the surgical group had decreased the number of medications they took for other medical problems, and fewer than 10% of the surgical patients still required insulin to control their blood sugar. The surgical patients saw improvements in their heart function, kidney function, triglyceride levels, and quality of life compared to the medication only patients.
This study marks one of the most compelling studies to date supporting the use of bariatric surgery to help patients in the fight against diabetes. The fact that patients who are less obese, and are not currently eligible for surgery based on insurance guidelines, also benefit in these other areas is certain to spark further debate about who should be eligible and lead to more patients being offered a surgical option. But little doubt should exist at this point, that for those who patients with diabetes and who do meet the eligibility requirements, that bariatric surgery is the most effective weapon we have to combat type 2 diabetes.

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