Weight loss surgery provides long term control for type 2 diabetes

by Barbara Hewitt on April 1, 2014

Weight loss surgery is an effective and durable treatment for type 2 diabetics who are obese with a new study showing that it vastly reduces and even negates the need for medication.

The study by Cleveland Clinic in the United States found that bariatric surgery resulted in nearly all patients being free of needing insulin and in many case free of all diabetic medication three years after their operation.


Researchers were also able to evaluate the impact of diabetes and obesity on patients quality of life

It helped them to get their blood sugar to healthy levels, reduced the need for high blood pressure and cholesterol medicines and led to quality of life improvements compared with those who received medical weight loss therapy.

The study called Stampede involved 150 obese patients who had poorly controlled type 2 diabetes for at least eight years and compared two types of weight loss surgery against weight loss attained by diet and exercise along with nutrition counselling and, for some, additional diabetes medicines that can help promote weight loss.

All patients were already taking at least three diabetes drugs and at least three heart medicines. More than a third, 37.5%, of patients who underwent gastric bypass surgery and a quarter of those who had a sleeve gastrectomy procedure achieved blood sugar levels below the American Diabetes Association target and most no longer needed diabetes medicines, researchers said.

That compared with just 5% of patients in the medical therapy group who got their A1c blood sugar levels down to 6% or less. ADA recommendations call for A1c levels of 7 percent or less.

‘Initially we thought diabetes was a disease you could not reverse or end. We do realise now that there may be a treatment that could end diabetes for some people and that’s exciting,’ said Dr. Sangeeta Kashyap, one of the study’s lead investigators.

At three years, only 5% to 10% of the surgery patients who had been using insulin still needed the treatment, compared with a comparable rate 55% in the medical therapy group.

‘We see patients whose lives are ravaged by diabetes. 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,’ explained Kashyap.

‘More than 90% of the patients who underwent bariatric surgery were able to lose 25% of their body weight and control their diabetes without the use of insulin and multiple diabetes drugs,’ he added.

To date, the Stampede study is the largest randomised trial with one of the longest follow ups comparing medical therapy with bariatric surgery.

‘The three year data confirms that bariatric surgery maintains its superiority over medical therapy for the treatment of type 2 diabetes in severely obese patients,’ said lead investigator Philip Schauer, director of the Cleveland Clinic Bariatric and Metabolic Institute. ‘Moreover, data show that bariatric surgery is as effective in treating type 2 diabetes in patients with mild obesity,’ he added.

After three years, researchers were also able to evaluate the impact of diabetes and obesity on the patients’ quality of life and found significant improvements in five of eight mental and physical domains for patients in the gastric bypass group and two of eight domains for the patients in the sleeve gastrectomy group. There was no improvement in the medical therapy group.

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

In addition, new data looked at kidney function, measured by the amount of albumin in the urine and a marker of kidney damage due to diabetes. Albumin level was significantly lower in the gastric bypass group only.

Cleveland Clinic researchers have been at the forefront of research in this field and another study has showed for the first time that bariatric surgery can markedly improve type 1 diabetes, with some patients reducing their insulin intake by more than 60%.

The opinions expressed in this article do not necessarily reflect the views of the DiabetesForum.com Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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