Bariatric Surgery Best for Obese Diabetics

Bariatric surgery improves glycemic control better than optimal medical therapy alone for obese patients with type 2 diabetes, two randomized trials determined.

Hemoglobin A1c levels normalized to under 6% by 1 year for 42% of patients who got gastric bypass surgery and 37% who got sleeve gastrectomy compared with 12% on intensive medical therapy alone (P=0.002 and P=0.008), Philip R. Schauer, MD, of the Cleveland Clinic, and colleagues reported in the STAMPEDE trial.

After 2 years in a second trial, diabetes went into remission with fasting glucose under 100 mg/dL and A1c under 6.5% off medication in 75% of gastric bypass patients and 95% of biliopancreatic diversion patients compared with none on conventional medical therapy.

Metabolic control also improved more in the surgery groups of both trials, appearing online in the New England Journal of Medicine.

“Although type 2 diabetes has been the domain of physicians, surgeons may now be able to claim greater success in achieving improved metabolic control,” an accompanying editorial suggested, calling the results likely practice changing.

These two studies provide evidence that in obese patients with type 2 diabetes, surgery can be more effective that either standard or intensive medical treatment alone.

Point out that in both studies, bariatric surgery (gastric bypass, biliopancreatic diversion or sleeve gastrectomy) induced remission and was associated with a significant improvement in metabolic control over and above medical therapy, whether conventional or intensive.

Longer term and larger studies are needed to prove a durable benefit and whether the results would be as good in routine practice, noted editorialists Paul Zimmet, MD, PhD, of the Baker IDI Heart and Diabetes Institute, Melbourne, Australia, and K. George M.M. Alberti, DPhil, of King’s College Hospital in London.

Bariatric Surgery is a procedure performed on people who are dangerously obese, for the purpose of losing weight. This surgery is performed on the stomach and intestine causing a reduction of the patient’s food intake. It changes the anatomy of your digestive system to limit the amount of food you can eat and digest. Results from this obesity surgery are significant long-term weight loss, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality. After this surgery, resuming your normal life will require changes in your lifestyle.

Although Bariatric surgery requires a in general hospital stay of 1-2 days it is a permanent procedure that requires a lifetime commitment to maintaining a healthy lifestyle. Benefits of bariatric surgery are not limited to weight loss, but can help improve your overall health, well-being and self-esteem. The National Institutes of Health recommend bariatric surgery for obese people with a BMI of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes. Bariatric surgery is an excellent alternative for people who cannot lose significant weight through exercise and dieting and whose general health is compromised.

“Meanwhile, the success of various types of bariatric surgery suggests that they should not be seen as a last resort,” they wrote. “Such procedures might well be considered earlier in the treatment of obese patients with type 2 diabetes.”

American Experience
The STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial was presented at the American College of Cardiology meeting in Chicago in conjunction with NEJM publication.

Eating After Bariatric Surgery

Your diet changes immediately after bariatric surgery. You are restricted to a clear liquid diet (foods such as clear broth, diluted fruit juices or sugar-free gelatin desserts). This diet is continued until the gastrointenstinal tract has recovered from the bariatric surgery, generally one-three days. The next stage is a bland diet consisting of blended or pureed foods for at least two weeks. (This diet may consist of skimmed milk, cream of wheat, a small pat of margarine, protein drinks, cream soup, pureed fruit and mashed potatoes with gravy).

Post surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting. Diet restrictions after recovery from this surgery depend in part on the type of surgery. Many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients after their surgery. Because patients cannot eat a large quantity of food, physicians typically recommend a diet that is relatively high in protein and low in carbohydrates and alcohol. A controlled diet after your bariatric surgery will also enhance your changes of greater weight loss and helps you achieve a healthier lifestyle.

It included 150 obese patients with a body mass index of 27 to 43 kg/m2 (mean 36, 34% under 35 kg/m2) and uncontrolled diabetes with a hemoglobin A1c over 7.0% (mean 9.2%) randomized to Roux-en-Y surgery or sleeve gastrectomy or medical therapy alone.
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