ACC: Bariatric surgery improves glycemic control in diabetes

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ACC: Bariatric Surgery Improves Glycemic Control in Diabetes
ACC: Bariatric Surgery Improves Glycemic Control in Diabetes

HealthDay News -- For obese patients with uncontrolled type 2 diabetes, bariatric surgery significantly improved glycemic outcomes compared with medical therapy alone, study data indicate.

"[B]ariatric surgery represents a potentially useful strategy for management of uncontrolled diabetes, since it has been shown to eliminate the need for diabetes medications in some patients and to markedly reduce the need for drug treatment in others," Philip R. Schauer, MD, from the Cleveland Clinic, and colleagues reported online in the New England Journal of Medicine. The study's publication coincided with it's presentation at the annual meeting of the American College of Cardiology in Chicago.

The researchers randomly assigned 150 obese patients with uncontrolled type 2 diabetes (average HbA1c of 9.2%) to medical therapy alone, medical therapy plus Roux-en-Y gastric bypass, or medical therapy plus sleeve gastrectomy.

After one year, HbA1c was 6% or less in 12% of the medical-therapy group, 42% of the gastric-bypass group, and 37% of the sleeve-gastrectomy group. In all three groups, glycemic control improved, with mean HbA1c of 7.5% in the medical-therapy group versus 6.4% and 6.6% in the gastric-bypass and sleeve-gastrectomy groups, respectively.

Mean weight loss was significantly higher in the two surgical groups, at 29.4 kg and 25.1 kg for gastric bypass and sleeve gastrectomy, respectively, compared with 5.4 kg for the medical-therapy group. Patients who underwent surgery also had less need for glucose, lipid and BP lowering drugs, while patients who received medical therapy alone required more drugs.

"Theoretically, such improvements have the potential to reduce cardiovascular morbidity and mortality, as shown in nonrandomized studies, although such benefits will need to be balanced with surgical risk and safety as shown in larger, multicenter clinical-outcome trials," Schauer and colleagues concluded.

The study was funded by Ethicon Endo-Surgery. Several researchers disclosed financial ties to pharmaceutical and medical technology companies, including Ethicon Endo-Surgery.

Schauer PR et al. NEJM. 2012;doi:10.1056/NEJMoa1200225.

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