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May 2012
Dramatic blood sugar control withgastric surgery
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Radha Chitale
G
astric surgery controlled blood sugar
beer than intensive medical therapyamong obese type 2 diabetics, according tothe STAMPEDE trial, the results of whichwere presented at the 61st Annual ScienticSessions of the American College of Cardiol
-
ogy meeting in Chicago, Illinois, US.Patients who underwent Roux-en-Y gas
-
tric bypass surgery or sleeve gastrectomyachieved HbA1c control below 6 percentwithin a year in 42 percent (
P
=0.002) and37 percent of cases (
P
=0.008), respectively,compared with 12 percent who received in
-
tensive medical therapy alone. [
N Engl J Med
2012 Mar 26. Epub ahead of print]“Despite improvements in pharmacother
-
apy, fewer than 50 percent of patients withmoderate-to-severe type 2 diabetes actuallyachieve and maintain therapeutic thresholds,particularly for glycemic control,” said re
-
searchers from the Cleveland Clinic in Ohio,US, Veterans Aairs Boston Healthcare Sys
-
tem and Brigham and Women’s Hospital inBoston, Massachuses, US.“Observational studies have suggestedthat bariatric or metabolic surgery can rap
-
idly improve glycemic control...”The trial randomized 150 obese patients(mean age 49 years, mean body mass index36 kg/m
2
, mean HbA1c 9.2 percent) with un
-
controlled type 2 diabetes to receive inten
-
sive medical therapy alone, medical therapyplus Roux-en-Y gastric bypass surgery ormedical therapy plus sleeve gastrectomy.Intense medical therapy followed theguidelines of the American Diabetes Asso
-
ciation and included lifestyle counselling,weight management, and drug therapy.Patients randomized to surgery experi
-
enced signicantly more weight loss com
-
pared with those receiving medical therapyaer 12 months (-29.5 kg gastric bypass, -25.1kg sleeve gastrectomy, -5.4 kg medical ther
-
apy,
P
<0.001 for both) and lead author Dr.Philip Schauer, of the Cleveland Clinic, saidthis, more than anything else, was the likelydriver for glycemic control.Mean HbA1c was 6.4 percent in the gas
-
tric bypass group (
P
<0.001), 6.6 percent inthe sleeve gastrectomy group (
P
=0.003) and
Dramatic blood sugar control withgastric surgery
The STAMPEDE trial showed that gastric surgery
signifcantly lowered HbA1c levels compared with intensivemedical therapy alone in obese patients with type 2 diabetes.
3
May 2012
7.5 percent among patients receiving medi
-
cal therapy.Patients who underwent surgery also sig
-
nicantly reduced or halted use of glucosecontrol and cardiovascular medications.“Reductions in the use of diabetes medica
-
tions occurred before achievement of maxi
-
mal weight loss, which supports the conceptthat the mechanisms of improvement in dia
-
betes involve physiologic eects in additionto weight loss...” the researchers said.No deaths or life threatening complicationsoccurred although four patients required asecond surgery for complications.In an accompanying comment, Dr. PaulZimmet, Baker IDI Heart and Diabetes Insti
-
tute, Melbourne, VIC, Australia, and Dr. K.George M. M. Alberti, Kings College Hospi
-
tal, London, England, said surgery would not be the “universal panacea” for obese patientswith type 2 diabetes and pointed out that thestudy duration was only 1 year and that sur
-
gery has inherent hazards. [
N Engl J Med
2012Mar 26. Epub ahead of print]“There is also the problem of ‘remission’versus ‘cure,’” they said. “Type 2 diabetes isoen progressive, and worsening of glycemiccontrol over time is likely in many patients.However, some years of improved glycemiamay well result in less microvascular disease.”Both the researchers and commenterscalled for further studies on the long-termclinical eects of gastric surgery.
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