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Is surgery the answer to type 2 diabetes?

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Bariatric surgery has been hailed as the most effective treatment for type 2 diabetes following the findings of a study.

The study, by the Cleveland Clinic, examined 150 overweight patients with poorly controlled diabetes.

The patients were divided into three equal sized groups: in the first group, 50 patients received intensive medical therapy only; in the second group, 50 patients underwent Roux-en-Y gastric bypass surgery and received medical therapy; and in the third group, 50 patients underwent sleeve gastrectomy and received medical therapy.

The effectiveness of treatment was gauged by the percentage of patients who achieved blood sugar control, defined as haemoglobin HbA1c levels of less than or equal to 6.0.

After three years, more patients in the gastric bypass group – 37.5 per cent – achieved blood sugar control without the use of any diabetic medications compared with the other two groups – 5 per cent of the patients in the medical therapy group and 24.5 per cent of patients in the sleeve gastrectomy group.

The study found that patients who underwent bariatric surgery experienced an improvement in quality of life, and a reduction on the need for cardiovascular medications to control blood pressure and cholesterol compared with those receiving medical therapy.

As a result, patients in the surgery group used less cardiovascular and glucose lowering medications – 5 to 10 per cent were on insulin, compared with 55 per cent of patients in the medical therapy group.

One of the lead researchers, Dr Sangeeta Kashyap, said patients who underwent bariatric surgery lost five to six times more weight than those in the intensive medical therapy group.

“We see patients whose lives are ravaged by diabetes,” Dr Kashyap said. “At the three-year mark, this study shows that bariatric surgery is more effective, with persistent benefits noted up to three years, for treating type 2 diabetes in moderate and severely obese patients, when compared to medical therapy.

“More than 90 per cent of the patients who underwent bariatric surgery were able to lose 25 per cent of their body weight and control their diabetes without the use of insulin and multiple diabetes drugs.”

The researchers also evaluated the impact of diabetes and obesity on a patient’s quality of life.

They found significant improvements in five of eight mental and physical domains for patients in the gastric bypass group, compared with improvements in two of eight domains for patients in the sleeve gastrectomy group. There was no improvement in the medical therapy group.

Another lead researcher, Dr Philip Schauer, said the three-year data confirmed that bariatric surgery maintained its superiority over medical therapy for the treatment of type 2 diabetes in severely obese patients.

“We looked at quality of life, because ultimately it is about helping our patients live a healthier, happier life,” Dr Schauer said. “When compared to sleeve gastrectomy and medical therapy, gastric bypass patients achieved greater weight loss, were on fewer medications, and had a higher success rate in controlling their diabetes and an improved quality of life.”

The study was part of the Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently trial and was published in Diabetes Care.

Kirsty Waterford

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