Greater Role for Bariatric Surgery in Treating Type 2 Diabetes

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Two Randomized Clinical Studies in The New England Journal of Medicine Support Far Greater Role for Bariatric Surgery in Treating Type 2 Diabetes

  • First head-to-head studies comparing bariatric surgery to medical therapy published in NEJM
  • Bariatric surgery superior to medical treatment producing remission, even before weight loss
  • More patients need access to this important option sooner

Two randomized clinical trials published this week in The New England Journal of Medicine demonstrate bariatric surgery is the most effective treatment for type 2 diabetes in obese and morbidly obese patients and suggest surgery should be considered sooner and more often for patients battling the twin epidemics of diabetes and obesity. These are the first head-to-head trials comparing surgery to medical treatment.

In the study conducted by Schauer et al from Cleveland Clinic, within one year, diabetes remission rates with bariatric surgery were about 40 percent (42% gastric bypass, 37% gastric sleeve) compared to about 12 percent for patients treated with the best pharmacotherapy available. Patients had a body mass index (BMI) between 27 and 43.

In the two-year study conducted by Mingrone et al from Catholic University of Rome Italy and New York-Presbyterian/Weill Cornell Medical Center, remission rates were about 85 percent for bariatric surgery (75% gastric bypass, 95% biliopancreatic diversion) and zero for medical therapy in patients with BMI greater than 35. In the surgical groups, both weight loss and preoperative BMI were not predictors of diabetes control, which suggest that such surgical procedures may exert effects on diabetes that are independent of weight loss.

These ground breaking studies will have a major impact on the future of diabetes treatment as clinicians, patients, government officials and insurers absorb the data and its implications. But while bariatric surgery proved more effective than medical therapy for type 2 diabetes, the real winner is patients, who may now gain greater access to a safe and proven treatment that has been denied too long to too many.

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012. DOI: 10.1056/NEJMoa1200225.

Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012. DOI: 10.1056/NEJMoa1200111.