Bariatric surgery could be a potentially effective “tool” for treating type 2 diabetes. A new study found that patients with type 2 diabetes who underwent bariatric surgery for three years returned to normal blood glucose levels and no longer required diabetes medications such as insulin. The study was published in the March 31 issue of the New England Journal of Medicine (NEJM).
Researchers at the nation’s top Cleveland Clinic conducted a three-year trial called Surgery and Medication to Eliminate Diabetes (STAMPEDE).
STAMPEDE was a three-group randomized controlled single-center trial (medication, gastric bypass surgery, and sleeve gastric reduction groups) that included 150 obese patients with at least eight years of type 2 diabetes that was not well controlled. The trial was randomized using zone groups to assign patients 1:1:1 according to the baseline of insulin use. Selection criteria were age 20-60 years, glycosylated hemoglobin HbA1c level >7.0% and body mass index (BMI) value 27-43 kg/m2. all patients were already taking at least 3 diabetes medications and at least 3 cardiac medications.
The results showed that after three years, 38% of patients in the gastric bypass bariatric surgery group and 24% of patients in the sleeve gastrectomy group had reduced their HbA1c levels to 6% and below, and most (>90%) of the patients who underwent surgery no longer required oral diabetes medications or insulin for glycemic control. In contrast, only 5% of patients in the medication group had reduced their blood glucose levels to 6% or less, and 55% of patients still required insulin. (The American Diabetes Association recommends glycosylated hemoglobin control at less than 7%, the International Diabetes Federation recommends glycosylated hemoglobin control at less than 6.5%, and China has set the glycosylated hemoglobin control standard for diabetics at less than 6.5%.)
“Exciting! We initially thought diabetes was irreversible or incurable. We are now realizing that some diabetics are curable.” Sangeeta Kashyap, one of the leaders of the study, said.