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Wednesday, 28 May 2014 10:42

Treating Severe Type 2 Diabetes in Obese Individuals: Bariatric Surgery Versus Intensive Medical Therapy

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It is imperative for diabetic individuals that their blood sugar levels remain under good control because uncontrolled diabetes can lead to even more serious conditions, so-called complications of diabetes, that may include coronary artery disease, kidney disease, and so on.

All concerned must have heard about Bariatric surgery. It is the collective name given to the surgical procedures carried out to achieve weight loss and are usually reserved for those severely obese individuals who have failed upon other methods of weight loss.

It should be now general knowledge that obesity strongly associated with type 2 diabetes. In patients harboring both the conditions simultaneously; the danger of dreadful outcome gets multiplied.

Bariatric surgery has recently started emerging as a potentially useful treatment for uncontrolled diabetes in severely obese individuals. Studies suggest that all different types of surgical weight loss surgeries, namely Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, and biliopancreatic diversion go a long way in achieving desired blood sugar levels as well as prevent serious complications of uncontrolled diabetes.

Results of a 3 years long study at Cleveland Clinic to evaluate the long term benefits of bariatric surgery were recently evaluated. In a study entitled as 'Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently' (STAMPEDE) , a total of 150 patients were randomized into three groups: intensive medical therapy only, intensive medical therapy plus Roux-en-Y gastric bypass or intensive medical therapy plus sleeve gastrectomy. The primary end point was achieving a level of glycated hemoglobin (HbA1c) less than 6 %.

After three years the percentage of patients in three different groups who succeeded in achieving the end point of HbA1c 6% was as follows:

  • Intensive medical therapy alone group: 5 % of patients
  • Intensive medical therapy plus gastric bypass group: 37.5 %
  • Intensive medical therapy plus sleeve gastrectomy group: 24 %


  • The surgical group also showed great improvement in metabolic syndrome components including BMI, waist circumference, triglycerides and HDL levels compared to those receiving medical therapy alone.
  • Patients in two surgical groups also had significant reduction in the use of antihypertensive and lipid-lowering medicines
  • 5 to 10% of these patients were using insulin compared to 55% of those in the medical therapy group

From the Bariatric and Metabolic Institute (P.R.S., S.A.B., A.A.), Lerner Research Institute (J.P.K.), Heart and Vascular Institute (K.W., C.E.P., E.S.H.K., S.E.N.), Urological and Kidney Institute (S.D.N.), and Endocrinology Institute (S.R.K.), Cleveland Clinic, Cleveland; and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School — both in Boston (D.L.B.).

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