Currently required fda labeling for oral hypoglycemic agents includes the following wording: “There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with _____ or any other antidiabetic drug.” Since cardiovascular events are the No. 1 cause of death in type 2 diabetes, what does work?
The Swedish Obese Subjects study is a prospective trial that enrolled patients for bariatric surgery vs “usual care” between 1987-2001, and continues to follow their outcomes. Surgical interventions include nonadjustable banding (n = 61), vertical banded gastroplasty (n = 227), and gastric bypass (n = 55).
Remission of type 2 diabetes subsequent to surgery was impressive: At 2 years, 72% of surgical patients remained in remission, and at 15 years, still 30% of type 2 diabetes patients were in remission (compared with 16% and 7%, respectively, in the “usual care” group). Both microvascular complications (twice as frequent in the control group) and macrovascular endpoints (32% fewer in the surgical group), favored bariatric surgery patients.
The evidence accumulating on bariatric surgery has been consistently favorable, including perioperative 90-day mortality rates of < 1%. Benefits of bariatric surgery are prompt and enduring.
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