Bariatric Surgery versus Intensive Medical Therapy for Diabetes -- 3-Year Outcomes

In case anyone is on the fence about surgery (or needs additional confirmation that you made an awesome decision)...here's an article that was published today in the New England Journal of Medicine...one of the best medical journals around. If you want the full text, PM me.

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes

Philip R. Schauer, M.D., Deepak L. Bhatt, M.D., M.P.H., John P. Kirwan, Ph.D., Kathy Wolski, M.P.H., Stacy A. Brethauer, M.D., Sankar D. Navaneethan, M.D., M.P.H., Ali Aminian, M.D., Claire E. Pothier, M.P.H., Esther S.H. Kim, M.D., M.P.H., Steven E. Nissen, M.D., and Sangeeta R. Kashyap, M.D. for the STAMPEDE Investigators

March 31, 2014DOI: 10.1056/NEJMoa1401329

Background

In short-term randomized trials (duration, 1 to 2 years), bariatric surgery has been associated with improvement in type 2 diabetes mellitus.

Methods

We assessed outcomes 3 years after the randomization of 150 obese patients with uncontrolled type 2 diabetes to receive either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary end point was a glycated hemoglobin level of 6.0% or less.

Results

The mean (±SD) age of the patients at baseline was 48±8 years, 68% were women, the mean baseline glycated hemoglobin level was 9.3±1.5%, and the mean baseline body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.0±3.5. A total of 91% of the patients completed 36 months of follow-up. At 3 years, the criterion for the primary end point was met by 5% of the patients in the medical-therapy group, as compared with 38% of those in the gastric-bypass group (P=0.01). The use of glucose-lowering medications, including insulin, was lower in the surgical groups than in the medical-therapy group. Patients in the surgical groups had greater mean percentage reductions in weight from baseline, with reductions of 24.5±9.1% in the gastric-bypass group and 21.1±8.9% in the sleeve-gastrectomy group, as compared with a reduction of 4.2±8.3% in the medical-therapy group.

Hey, haven't seen you post in a while. I know you are the scientific type. Did you see the recent study published by the University of Cincinnati about VSG and how the research they did shows a change in gut chemistry and the bacteria and they thing the successful weight loss has more to do with that than the actual surgery. I only read a news article about it, so it was only halfway accurate. But it went on to say they are doing further research to see if they can come up with a pharma approach that could accomplish the same thing. I will see if I can find the article and see if it referenced the actual study location. I don't recall it mentioning it.

Here is the article:

http://healthnews.uc.edu/news/?/24172/

I'll look at it.

I lurk, but don't post often. Often the case of many of us...

OH THATS GREAT ( said sarcastically)

big Pharma's loosing money b/c WLS for the most part puts into remission

type 2 and high BP so hey they come up w yet another pill to market and make $$$$$

HEY if you take this magic pill.... No need for WLS!

and who wants BIG BAD SURGERY..when you can just take a pill...FOR....THE....REST...OF...YOUR...LIFE!!!!

I am not sure this was driven by big pharma but I didn't read who funded the study, you could be right. I just think the research found a significant difference that they assume can be emulated some other way. At the end of the day it is a combination of things that make VSG successful.

:)

The study wasn't funded by Pharma. 3 part funding by NIH, Cleveland Clinic, and Ethicon (which I guess is technically pharma, but surgical pharma and has a vested interest in a pro-surgical outcome...).

UGH. OH is being a &%R&%^ and chopping my post. Here's the rest.

Conclusions

Among obese patients with uncontrolled type 2 diabetes, 3 years of intensive medical therapy plus bariatric surgery resulted in glycemic control in significantly more patients than did medical therapy alone. Analyses of secondary end points, including body weight, use of glucose-lowering medications, and quality of life, also showed favorable results at 3 years in the surgical groups, as compared with the group receiving medical therapy alone. (Funded by Ethicon and others; STAMPEDE ClinicalTrials.gov number, NCT00432809.)

Interesting article, thanks for posting it. It seems all the world is looking at gut microbial ecosystems as the obesity smoking gun and this points in that direction as well.

i am glad to see facts that will perhaps change the opinion/influence of some here who say that WLSers are doomed to fail if they don't have a specific sleeve size.

laurie