Surgery: Six Times Better for Controlling Type 2 Diabetes
Today in the New England Journal of Medicine, five-year results of a randomized, controlled trial show that bariatric surgery is six times better than intensive medical treatment for controlling type 2 diabetes. That’s right. Six times better chances for success after five years. Without surgery, the outcomes were dramatically worse.
This study, known as the STAMPEDE study, randomized 150 patients with type 2 diabetes and excess weight to receive intensive medical care, gastric sleeve surgery, or gastric bypass surgery. The weight status of these patients covered a wide range. Some had only a bit of excess weight, with BMIs as low as 27. Some had severe obesity with BMI as high as 43.
After five years, only five percent of the patients with intensive medical care had their diabetes under control with an A1C under 6%. Among gastric bypass patients, 29% had their diabetes under control after five years. For gastric sleeve patients, the number was a bit lower – 23%. But that difference was not statistically significant. Both surgeries were better than intensive medical care.
Even in patients with lower BMI (27-34) the surgery patients achieved significantly better outcomes.
Surgery proved to be superior in other ways, too. With surgery, people maintained a healthier weight, took less medicine, and enjoyed a better quality of life. People in the surgery group reported less pain and better general health than people in the medical treatment group. Mild anemia was the only adverse event more common in the surgery patients.
The evidence favoring surgery in people with excess weight and type 2 diabetes could hardly be more clear. Type 2 diabetes devastates the body and shortens lives. And yet, people who could benefit still hesitate. One reason is that the threat of diabetes is a bit more distant. The complications and suffering that diabetes will cause are abstract, future events. The costs and risks of surgery are intimidating and immediate.
Faced with an immediate cost for a future benefit, people need reassurance that the tradeoff is a good one. Health professionals would ordinarily be the source for that reassurance. But in a recent Medscape survey, endocrinologists and primary care providers said they recommend bariatric surgery for only 12-14% of their patients with obesity. Some are just slow to catch up. Others don’t want to be bothered with the facts. Sticking with deep biases and blaming the patient is easier.
Providers owe their patients better advice. Patients need the support of wise healthcare professionals to make good decisions.
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February 16, 2017