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Bariatric Surgery: Latest News
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STAMPEDE trial (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently) shows that surgical therapy beats standard medical therapy in obese patients with Type 2 Diabetes
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Surgeons at the Cleveland Clinic reported the results of a clinical trial to compare the effects of advanced medical (pharmacological) therapy versus bariatric surgery on blood sugar control in patients with Type 2 diabetes.
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This study, published in the New England Journal of Medicine is the first randomized controlled clinical trial with a head-to-head comparison of intensive medical (pharmacological) treatment versus bariatric surgery in the treatment of Type 2 diabetics. Click here for a pdf copy of this study.
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The trial involved 150 men and women with a clinical diagnosis of Type 2 diabetes, between the ages of 20 and 60 years old with a Body Mass Index (BMI) of 27 – 43.
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This Is one of the first times doctors have studied the effects of weight loss surgery for diabetic patients who aren’t severely obese (typically, bariatric surgery is performed on patients with a BMI of over 35).
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These 150 patients were randomly assigned to receive either medical therapy, Roux-en-Y gastric bypass or sleeve gastrectomy. The mean age was 49 years and the mean preoperative HbA1c (a measure of glycemic control) was 9.2%.
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The main study outcome after 12 months of treatment was met by 12% of the medical therapy group, 42% of the Roux-en-Y gastric bypass group and 37% of the sleeve gastrectomy group. Although glycemic control improved in all three groups, improvements were significantly greater in the surgical groups, as was weight loss and insulin resistance.
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In this study, bariatric surgery induced remission and was associated with a significant improvement in metabolic control over and above medical therapy, both conventional and intensive," say Dr Paul Zimmet (Heart and Diabetes Institute, Melbourne, Australia) and Dr George MM Alberti (King's College Hospital, London, UK) in an accompanying editorial. "This study . . . is likely to have a major effect on future diabetes treatment," they add. Such procedures should no longer be considered as a last resort in diabetes and "might well be considered earlier in the treatment of obese people with type 2 diabetes. Who could predict that years after the discovery of insulin that surgeons would be challenging the physician's territory for treating diabetes?"
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