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Surgery Beats Meds For Diabetes Three Years In A Row – And Counting



sharma-obesity-blood-sugar-testing2This week, the New England Journal of Medicine publishes the three-year follow-up of the STAMPEDE trial, an ongoing randomized controlled trial of intensive medical care vs. sleeve gastrectomy vs. gastric bypass in patients with type 2 diabetes (regular readers may recall a previous post on this study).

Now, at 36 months follow-up (for 91% of participants), only 5% of medically treated patients met the primary end point of the study (an A1C less than 6%) compared to 38% in the gastric bypass group and 24% in the sleeve gastrectomy group.

Overall, the use of glucose-lowering medications, including insulin, was lower in the surgical groups than in the medical-therapy group.

Much of this difference may well be explained by weight loss – while the medical group lost about 4% of initial body weight, the bypass group lost 25% and the sleeve gastrectomy group lost 21%.

All measures of quality-of-life were better in the two surgical groups.

There were no major late surgical complications.

So, consistent with the two-year findings, at three years, surgical patients appear to be still benefitting substantially from the surgical treatment.

How I wish we had effective medical treatments for obesity that could begin matching these surgical outcomes.

After all, as effective as surgery may be – it will always only be available to a tiny fraction of people who need it.

@DrSharma
Edmonton, Alberta

Disclaimer: I am a consultant to Ethicon Endosurgery, the sponsor of this trial.

4 Comments

  1. Your last comment interests me. You say “as effective as surgery may be – it will always only be available to a tiny fraction of people who need it”…I suspect people said that about the early days of total joint arthroplasty or cataract replacement. Those interventions were acknowledged at being the only significantly effective treatments for their specific ailments–and look at them now.

    Things always change in medicine and surgery–my grandfather was a surgeon and he rarely did a cholecystectomy–but he had regular lists of gastric surgery for ulcer disease. Never say never…

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    • No doubt bariatric surgery will be around for a long time – it took two decades to replace coronary bypass surgery – first with medical devices, now mostly medication. It would take a 10,000 fold increase in the annual rate of bariatric surgery to treat all diabetic patients – I am simply not that optimistic that we will be seeing 100,000 or more bariatric/metabolic surgeries a year in Canada.

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  2. But what about people who have Type-2 Diabetes who are not obese? I’m assuming that bariatric surgery is only appropriate for people with really high BMI. What if you’re simply in the “overweight” (BMI 25-30) category and have Type 2?

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  3. How I wish there were fewer people with obesity.

    When I write that I can hear the outcry…
    “You’re fat shaming!!” “That’s ant-fat bias!!” ” There is Health At Every Size” (distorted to mean obesity has nothing to do with health)

    I think there is a cultural change going on that will be similar to the cultural change around smoking.
    There will be ups and downs, but eating oneself to obesity will eventually be as outmoded as smoking oneself to lung cancer.

    True, there are people who are obese for reasons other than what they eat – disease, drug therapy, syndromes, psychiatric conditions – medical causes needing medical treatment, and the more research and treatments the better.

    But for most of us who are obese, or who want to not become obese, it all comes down to eating right. There are cultures in which people do that. Tough as it is, I think we need to aim for that goal.

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