Bariatric surgery improved blood sugar control, reduced the need for medications and improved the quality of life for obese patients with Type 2 diabetes, according to a three-year follow-up study published this year.
Compared to intensive medical therapy alone, bariatric surgery allowed 90 percent to 95 percent of obese patients with Type 2 diabetes to stop taking insulin, while many did not need other diabetes medications three years after surgery. The patients also reduced their need for high blood pressure- and cholesterol-lowering medications.
The study shows that bariatric surgery is an option for obese patients with diabetes, although co-author Deepak Bhatt, MD, professor of medicine, Harvard Medical School and executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital Heart & Vascular Center in Massachusetts, advises caution.
“We need to be prudent in our use of invasive surgical approaches that carry healthcare costs,” said Bhatt, also a national American Heart Association volunteer. “If someone’s overweight with diabetes and everything else is not working, it’s something to consider strongly.”
Published in the New England Journal of Medicine the results of the ‘Bariatric Surgery versus Intensive Medical Therapy for Diabetes – 3-Year Outcomes,’ are among the top scientific cardiovascular developments in 2014, as determined by the American Heart Association.
Patients in the surgery groups used less cardiovascular and glucose-lowering medications. Five percent to 10 percent were on insulin compared to 55 percent of the patients in the medical therapy group.
According to the American Heart Association, obesity is a major risk factor for cardiovascular disease and has been strongly associated with insulin resistance, a precursor to Type 2 diabetes. Weight loss can improve cardiovascular risk, decrease insulin levels and increase insulin sensitivity. At least 65 percent of people with diabetes die from heart disease or stroke.
The trial initially involved 150 overweight patients with poorly controlled diabetes. The patients were divided into three groups:
- Fifty patients received intensive medical therapy only, including counseling and medications;
- Fifty patients received gastric bypass surgery and medical therapy;
- Fifty patients received sleeve gastrectomy and medical therapy. After three years, 35 percent of patients in the gastric bypass group were able to control their blood sugar to the lowest reported levels without diabetes medications compared to the other groups — none receiving medical therapy only and 20 percent who had sleeve gastrectomy. Bariatric surgery patients averaged five to six times greater weight loss than the medical therapy group.
As many as 3 million to 4 million people could benefit from bariatric surgery, according to Robert Eckel, M.D., professor of medicine and the Charles A. Boettcher Endowed Chair in Atherosclerosis at the University of Colorado School of Medicine in Denver. He said people considering bariatric surgery should “rely on their diabetologist, get several opinions, get online.”
There are few risks of bariatric surgery in the hands of experienced surgeons, added Eckel, a past president of the American Heart Association.
After three years, researchers used a questionnaire to determine the impact of diabetes and obesity on the patients’ quality of life. Patients in the gastric bypass group and sleeve gastrectomy group improved their quality of life. Those in the medical therapy group did not.
“We looked at quality of life, because ultimately it is all about helping our patients live a healthier, happier life,” said lead investigator Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute in Ohio. “When compared to sleeve gastrectomy and medical therapy, gastric bypass patients achieved greater weight loss, were on fewer medications, had a higher success rate in controlling their diabetes and an improved quality of life.”
Read other top 2014 research: Top Cardiovascular Disease Research Advances of 2014 Summary
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