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.

Click here for the study in NEJM, here for more from ScienceNews, and here for more from the New York Times.

Six, photograph © Steve Snodgrass / flickr

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February 16, 2017

8 Responses to “Surgery: Six Times Better for Controlling Type 2 Diabetes”

  1. February 16, 2017 at 6:40 am, Joe Gitchell said:

    This is very cool, Ted–thank you.

    Only quibble (and happy to talk offline if helpful): in your first para, you use odds and risks/chances interchangeably (I think)–and Saul would slap your wrist!

    I think you likely mean risks/chances and not odds (but I only read the abstract not the full paper).


    • February 16, 2017 at 7:24 am, Ted said:

      Thanks Joe. All better now.

  2. February 16, 2017 at 9:14 am, Joe Gitchell said:

    Perfect, Ted.


  3. February 16, 2017 at 10:07 am, Allen Browne said:

    Of course another way to look at it would be that the results from intensive medical management are not too good – < 5% with diabetes under control. We need to continue to look for better tools and management schemes. And we know they are there – look at the results with bariatric surgery. But "acceptability" is a problem for the patients and the providers.

    Much work (opportunity) exists.

    • February 16, 2017 at 10:16 am, Ted said:

      You’re right Allen. Surgery is not a great option. It’s just the best we have for someone with diabetes and excess weight. By far.

      If I wear out my hip, my best option might be a hip replacement. My doctor won’t tell me I’m weak because I let the pain bother me and opt for surgery.

      But in obesity, he likely will tell me I’m weak if I go for surgery. Or he’ll say it without saying it.

      Guided by bad advice, many people will take their chances with diabetes complications that lie in a seemingly distant future.

  4. February 17, 2017 at 2:44 am, Amani kamal said:

    Thanks, Ted.

  5. February 17, 2017 at 3:34 pm, Allen Browne said:

    Actually surgery is a great option, but my point is how to help those who don’t get surgery for whatever reason – logical or not. There is a reality to the acceptability of surgery which defies logic and reason.

    • February 17, 2017 at 4:01 pm, Ted said:

      You’re right, Allen. Lots of unmet needs.