(By Owen Haskin, from BariatricNews.net)
Metabolic or bariatric surgery may be more effective than standard medical treatments for the long-term control of type 2 diabetes in obese patients, according to a study by King’s College London and the Universita Cattolica in Rome, Italy. The study, ‘Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial’, published in the Lancet, is the first to provide data on five-year outcomes of surgery from a randomised clinical trial specifically designed to compare this new approach against standard medical therapy for the treatment of type 2 diabetes.
“The results of this study add to a growing body of evidence showing that the gastrointestinal tract is a rational biological target for antidiabetic interventions and support implementation of surgery as a standard option in the treatment of type 2 diabetes,” said Professor Francesco Rubino, senior author of this study and Chair of Bariatric and Metabolic Surgery at King’s College London and a Consultant Surgeon at King’s College Hospital in London, UK. “The ability of surgery to greatly reduce the need for insulin and other drugs suggests that surgical therapy is a cost-effective approach to treating type-2 diabetes.”
Although a number of studies have shown that bariatric or weight-loss surgery can result in dramatic improvement of type-2 diabetes in obese patients, supporting the idea that surgery could be used to treat this disease. To date no trials have yet provided information on longer-term (five year) outcomes.
Overall, 19 (50%) of the 38 surgical patients of this study maintained diabetes remission at five years, compared with none of the 15 medically treated patients. Regardless of remission, surgical patients had generally lower levels of blood glucose than medically treated ones. Throughout the study period, surgical patients also used significantly less anti-diabetic and cardiovascular medication. The estimated cardiovascular risk at year five for surgical patients was roughly half that of patients receiving conventional treatment. Surgery was also associated with better quality-of-life scores.
Half of the patients who had initial diabetes remission experienced relapse of mild hyperglycaemia five year after surgery. For this reason, the authors caution that monitoring of glycaemia should continue in all patients who experience disease remission after bariatric surgery.
“Roux-en-Y gastric bypass and biliopancreatic diversion were both more effective than standard medical treatment for the long-term control of hyperglycaemia and for patients’ overall metabolic profile,” the authors write. “Surgery also resulted in a greater reduction of cardiovascular risk, diabetesrelated complications, and medication use, including glucose-lowering drugs, insulin, and cardiovascular drugs. Furthermore, surgical patients had a better quality of life than medically treated patients.”
Fewer diabetes-related complications were also observed in surgical patients in this study; however, the authors caution that the limitations of this trial, especially its relatively small sample size, do not allow definitive conclusions about the ability of surgery to reduce diabetes complications such as heart attacks, strokes and kidney disease.
“The lower incidence of typical diabetes complications in this study is in line with previous findings from long-term non-randomised studies; however, larger and ideally multicentre randomised trials are needed to definitively confirm that surgery can reduce diabetes morbidity and mortality compared to standard medical treatment,” said Professor Geltrude Mingrone, first author of the study who is a Professor of Internal Medicine at the Universita Cattolica in Rome and a Professor of Diabetes and Nutrition at King’s College London. “Nevertheless, surgery appears to dramatically reduce risk factors of cardiovascular disease.”
– Dr Patrick