Bariatric surgery for obese type 2 diabetics may improve and even reverse diabetes, according to the findings of two randomized, controlled studies.
In one study, which included 150 obese patients with uncontrolled type 2 diabetes, researchers led by Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute, found that 42.6% of those who underwent gastric bypass surgery had a normal hemoglobin A1c level after 12 months compared with 36.7% of patients who underwent sleeve gastrectomy and only 12.2% of subjects treated with intensive medical therapy. In addition, the bariatric surgery patients had a significantly decreased need for antihypertensive and cholesterol medications.
“We believe that bariatric surgery represents a potentially valuable strategy for control of diabetes that should be considered in more patients who do not respond to conventional treatment,” Dr. Schauer said.
He also observed that the study “demonstrates that bariatric surgery can eliminate the need for diabetes medications in many obese patients who diabetes is poorly controlled.”
The other study, by Geltrude Mingrone, MD, of the Universita Cattolica S. Cuore in Rome, and collaborators, included 60 severely obese patients with type 2 diabetes randomized to receive conventional medical therapy or undergo bariatric surgery (either gastric bypass or biliopancreatic diversion). The primary outcome measure was the proportion of patients achieving diabetes remission. After two years, diabetes remission had occurred in 75% of the gastric bypass group, 95% of those who underwent biliopancreatic diversion, and none of the patients in the medical-therapy arm. Glycated hemoglobin levels decreased in all treatment arms, but the researchers observed the greatest improvement the two surgery groups.
The findings of both studies were published online ahead of print in the New England Journal of Medicine.
In an accompanying editorial, Paul Zimmet, MD, PhD, and K. George M.M. Alberti, DPhil, wrote that the two studies “are likely to have a major effect on future diabetes treatment.” Still, they added, more studies are needed, especially those that may provide better prediction of success and the expected duration of remission and long-term complications.
“Meanwhile, the success of various types of bariatric surgery suggests that they should not be seen as a last resort,” they concluded. “Such procedures might well be considered earlier in the treatment of obese patients with type 2 diabetes.”