Surgery Beats Meds For Diabetes Three Years In A Row – And CountingWednesday, June 4, 2014
This 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.
Disclaimer: I am a consultant to Ethicon Endosurgery, the sponsor of this trial.