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Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes

Bariatric Surgery for Obese Patients

Obesity and type 2 diabetes are epidemics that cause a great strain on the healthcare system. People that are categorized as obese have a higher risk for type 2 diabetes, heart disease, asthma, obstructive osteoarthritis, and sleep apnea. Similarly, people with chronic uncontrolled diabetes are at an increased risk for stroke, heart attack, blindness, and kidney disease. Recent advances in the treatment of diabetes, specifically the development of medications, have only marginally improved the outcomes for those patients with moderate to severe obesity. Taken together these findings underscore the need for more effective treatment strategies to target obesity and diabetes.

Benefits of Bariatric Surgery for Obese Patients with Diabetes

Researchers from the Cleveland Clinic Hospital recently published their findings of the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) Study. They found that bariatric surgery in severely obese patients (BMI of 30-35) with type 2 diabetes controlled their glycemic levels and reduced their risk for cardiovascular disease. The STAMPEDE study compared the medical outcomes of 140 obese patients with type 2 diabetes that separated into two groups: 1) intensive medical therapy or 2) bariatric surgery (gastric bypass or sleeve gastrectomy) plus intensive medical therapy. Based on the American Diabetes Association (ADA) guidelines, intensive medical therapy is defined as lifestyle counseling, weight management, at-home glucose monitoring, along with the use of diabetes medications. Dr. Schauer and his colleagues determined that bariatric surgery significantly decreased waist circumference, BMI, and body weight, relative to medical intervention alone. Gastric bypass was most effective at decreasing the triglycerides levels, which is a measurement of fats in the bloodstream. Similarly, there was a significant improvement of type 2 diabetes symptoms, namely a reduction in insulin resistance. The medical benefits of bariatric surgery were initially noticeable at 3 months after the surgery and persisted for at least 12 months post-surgery. Interestingly, in the patients that underwent bariatric surgery the patients no longer needed diabetes medications and this preceded their weight loss.

Bariatric Surgery is a Viable Treatment Option for Obese Patients with Diabetes

The take home message from this study is that bariatric surgery serves as a potentially useful therapeutic modality for unresolved diabetes because in some patients it completely eliminated the need for diabetes medications and in others it significantly reduced the amount of diabetic medications needed. Additionally, the patients that underwent bariatric surgery had marked improvements in their cardiovascular risk factors, which allowed their lipid-lowering and antihypertensive drugs to be reduced. Based on this study, bariatric surgery is a viable treatment option for obese patients with type 2 diabetes.

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