Target HbA1c achieved with bariatric surgery and no drugs
MedWire News: Obese patients with poorly controlled diabetes are significantly more likely to achieve a glycated hemoglobin (HbA1c) level of 6% or less if they combine medical therapy with either gastric bypass or sleeve gastrectomy than if they opt for medical therapy alone, show study findings.
Notably, many patients who undergo surgery, particularly gastric bypass surgery, achieve glycemic control without the use of diabetes medications, say Philip Schauer (Cleveland Clinic, Ohio, USA) and colleagues.
As reported in TheNew England Journal of Medicine, the team randomly allocated 140 diabetes patients with a mean body mass index of 36 kg/m2 to undergo either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy.
The intensive medical therapy included lifestyle counseling, weight management, and frequent home glucose monitoring and all patients were treated with lipid-lowering and antihypertensive medications, as recommended in the American Diabetes Association guidelines.
The researchers assessed the patients' body weight, waist and hip circumference, blood pressure, and HbA1c at baseline and at 3, 6, 9, and 12 months.
The researchers report that, at 12 months, a significantly greater proportion of people in the surgery groups achieved an HbA1c of 6% or less compared with those in the medical therapy group. Twenty-one of 50 (42%) patients who underwent a gastric bypass and 18 of 49 (37%) patients who underwent sleeve gastrectomy achieved an HbA1c of 6% or less, compared with only five of 41 (12%) patients who received medical therapy alone.
The difference in the proportion of patients achieving target HbA1c was not significant between the two surgical groups. However, all of the gastric bypass patients who achieved the target did so without medication, whereas five of the 18 (28%) patients who achieved the target after sleeve gastrectomy required the use of at least one glucose-lowering drug.
In addition, there was a significant reduction in the number of hypertension and hyperlipidemia medications required after the two bariatric procedures, compared with medical therapy alone, reports the team.
"Bariatric surgery represents a potentially useful strategy for management of uncontrolled diabetes, since it has been shown to eliminate the need for diabetic medications in some patients and to markedly reduce the need for drug treatment in others," conclude Schauer et al.
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By Sally Robertson