Bariatric Surgery Provides Long-Term Glycemic Control

Most obese patients who underwent bariatric surgery for type 2 diabetes sustained blood glucose and weight loss benefits that lasted at least five years, according to a new study.

Researchers at the Cleveland Clinic reported the final, five–year follow up results of the influential STAMPEDE trial, which at three years showed that diabetic patients who received bariatric surgery sustained significant drops in glycated hemoglobin (A1C) levels. The new follow up study reveals that after five years, more than 88% of both gastric bypass and sleeve gastrectomy patients maintained acceptable blood glucose levels without insulin, and that use of other cardiovascular and antidiabetic medications remained significantly reduced in both surgical groups.

The results further showed that 29% of gastric bypass patients and 23% of sleeve gastrectomy patients achieved and maintained normal A1C levels over the five-year period than patients who took medication for diabetes (5%). And patients who had surgery by either method sustained weight loss more than patients who controlled diabetes with medication, with weight loss being the primary reason their blood glucose remained in control. The study was presented at the American College of Cardiology (ACC) 65th annual scientific session, held during April 2016 in Chicago (IL, USA).

“Some advantages of gastric bypass over sleeve gastrectomy have emerged during follow-up; continued durability of glycemic control after metabolic surgery, as well as persistent weight loss and reduction in diabetes and cardiovascular medications,” said lead author Philip Schauer, MD. “Most clinical guidelines and insurance policies for bariatric surgery limit access to patients with a BMI of 35 or above. Our five-year results demonstrate that glycemic improvement in patients with a BMI of 27 to 34 is durable at least up to five years.”

The STAMPEDE study was among the first to suggest that reversing diabetes might not be merely the pleasant side effect of treatment for obesity, but perhaps should be considered as a reason for surgery in the first place. The original study reported positive A1C outcomes for patients with body mass index (BMI) levels as low as 27 kg/m2, below the CDC-defined obesity standard of a BMI of 30 kg/m2, and thus not considered as surgical candidates of obesity.

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