The benefits of bariatric surgery (BAS) are increasingly recognized for obese patients with type 2 diabetes mellitus (T2DM). Indeed, the mechanisms by which diversionary surgery (e.g., gastric bypass) produces such prompt and dramatic remission in diabetic patients are still being elucidated. Long-term observational data on BAS for persons with severe obesity (body mass index [BMI] > 40) confirm durable weight reduction, improved control of diabetes, and even suggest reduced mortality.
Few trials have directly compared the efficacy of BAS with intensive medical treatment (IMT). Kashyap et al randomized T2DM subjects (n = 60) with moderate obesity (mean BMI = 36) to one of two BAS interventions (gastric sleeve or gastric bypass) or IMT in the Surgical Therapy And Medications Potentially Eradicate Diabetes (STAMPEDE) trial. Currently reported data include outcomes at 24 months.
In essentially every category assessed, BAS patients had superior outcomes to IMT. No BAS-related deaths occurred. At 2 years, degree of A1c control, LDL, HDL, total cholesterol, triglycerides, and CRP were all more improved in the BAS patients than in the IMT patients.
When comparing outcomes in the two BAS groups, even though weight loss was similar between gastric sleeve and bypass surgery, the latter achieved greater improvements in truncal fat reduction, leptin, insulin sensitivity, beta cell function, and incretin responses. BAS is more effective for multiple metabolic markers than IMT over the long term in T2DM patients.
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