The final 5-year results of the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently trial of obese patients with uncontrolled type 2 diabetes showed that bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing or in some cases resolving hyperglycemia.
A previously reported, preliminary 5-year results were presented at the American College of Cardiology (ACC) 2016 Scientific Sessions in April. The final trial results, by Philip R Schauer, MD, from Cleveland Clinic, Ohio, and colleagues, were published in the February 15 issue of the
New England Journal of Medicine.
“We’re certainly not saying in this study that medications and lifestyle are not useful, but for some patients [with type 2 diabetes] who are refractory to lifestyle [changes] and medication and not controlled even with insulin, surgery is a very good option and has durable results out to 5 years,” senior author Sangeeta R Kashyap, MD, Cleveland Clinic, told
Medscape Medical News.
About one in four patients who had undergone
Roux-en-Y gastric bypass or
sleeve gastrectomy but only one in 20 patients who had received only intensive medical therapy attained the primary end point of HbA
1c <6% at 5 years.
Moreover, the “beneficial effects of bariatric surgery on glycemic control were durable, even among patients with mild obesity (body mass index [BMI] of 27–34), which led to a sustained reduction in the use of diabetes and cardiovascular medications,” Dr Schauer and colleagues report.
However, this was a small study, and a longer, larger multi-center study — which the group is planning to do — will be needed to confirm these findings and see whether the improved control of diabetes is tied to reduced risk of diabetes-related cardiovascular, renal, or ophthalmic disease.
Bariatric Surgery vs Medications Alone
STAMPEDE randomized 150 patients with uncontrolled type 2 diabetes (a mean HbA
1c of 9.2%) and a
BMI of 27 to 43 to receive intensive medical therapy alone, Roux-en-Y gastric bypass, or sleeve gastrectomy.
All patients met with clinicians every 3 months for 2 years and every 6 months for 3 years to receive adjustments in their intensive medical therapies with the goal of an HbA
1c of 6% without unacceptable side effects.
A total of 134 patients (89%) completed the 5-year trial. On average, when they entered the study, the patients (66% women) had been 49 years old and had had diabetes for 8.4 years, and 44% required insulin.
A total of 49 patients (37%) had mild obesity (BMI <35) at study entry. “Much of diabetes occurs at a BMI of about 30,” and these mildly obese patients tend to have greater visceral obesity, Dr Kashyap note
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Tragically, she has been eating herself to death — trapped inside a tiny apartment in Seattle, WA. She admits that she is addicted to food, and comforts herself by gorging on sweets and fast-food.
Diana’s skyrocketing weight has caused her vascular and lymphatic systems to start shutting down, and has led to her lymphedema.
A camera crew travels with Diana to Houston to see Dr. Younan Nowzaradan, a weight-loss doctor who counsels and vets patients for any sort of gastric Sleeve operation.
Her sister is at the wheel as we see the back of a passenger van hollowed out and turned into a makeshift ambulance with pillows and blankets and bedding. This trip is a long one, and unable to walk or get out on her own volition, Diana must evacuate her bladder and bowels in adult diapers and she requires numerous helpers and emergency assistance to get in and out of the car.
Diana admits: “I’ve been miserable for two days straight, and I cannot wait to get into a bed — but it’s embarrassing that I cannot even get out of a vehicle by myself.”
We see her sister call for non-urgent assistance from EMS to carry Diana to her room. They have to pull her out lengthwise and on to a sturdy gurney. After being wheeled inside, the firefighters then have to hoist her up to her bed. They cheerfully tell her that they will see her in the morning to reinsert her into the van so she can get to see Dr. Nowzaradan
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