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27-03-2012 | Surgery | Article

Bariatric surgery improves diabetes control in obese patients

Abstract

Free abstract

MedWire News: Bariatric surgery results in better glucose control than conventional medical therapy in obese patients with Type 2 diabetes, shows research.

Roux-en-Y gastric bypass and biliopancreatic diversion markedly ameliorated diabetes in patients involved in a randomized, controlled trial published in The New England Journal of Medicine.

"As many as 23% of patients with morbid obesity have type 2 diabetes… Conventional medical treatment of type 2 diabetes only partially achieves adequate glycemic control and a reduction in cardiovascular risk," explain Geltrude Mingrone (Catholic University of Rome, Italy) and colleagues. "Management of diabetes is particularly challenging in obese patients."

The study cohort comprised patients between 30 and 60 years old with a body mass index (BMI) of 35 kg/m2 or more who had at least a 5-year history of diabetes. The patients were assigned to receive one of three treatments: gastric bypass, biliopancreatic diversion, or medical therapy. Medical therapy included the use of oral hypoglycemic agents and insulin in combination with programs for diet and lifestyle modification.

At 2 years' follow up, diabetes remission had occurred in 75% of the 19 patients in the gastric-bypass group and in 95% of the 19 patients in the biliopancreatic-diversion group, but had not occurred in any of the 18 medical therapy group patients. Age, gender, baseline BMI, duration of diabetes, and weight changes were not significant predictors for diabetes remission at 2 years, or improvement in glycemia at 1 and 3 months.

At 2 years, the average level of glycated hemoglobin had decreased in all three patient groups, but the patients in the two surgery groups showed the greatest improvement (6.35% in the gastric-bypass group, 4.95% in the biliopancreatic-diversion group, and 7.69% in the medical therapy group).

The researchers say that, as there was no correlation between glucose levels and weight changes after bariatric surgery, their results may show that the effects of surgery on diabetes may be independent of weight.

"The preoperative BMI did not predict control of diabetes after either surgical procedure, which calls into question the current use of a strict BMI cutoff as a stand-alone criterion for surgical indications," they add.

In an accompanying editorial, Paul Zimmet (Baker IDI Heart and Diabetes Institute, Melbourne, Australia) and George Alberti (Kings College Hospital, London), write: "Is surgery, then, the universal panacea for obese patients with type 2 diabetes? We would answer, not yet.

"All controlled surgical studies to date have been short-term and have involved a relatively small number of patients."

By Chloe McIvor

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