At 3 years, glycemic control and quality of life were better with
surgery than with medical management.
In a previously published report from a randomized Cleveland Clinic
trial, Roux-en-Y gastric bypass and sleeve gastrectomy were more
likely than medical therapy (42% and 37% vs. 12%) to lower
glycosylated hemoglobin (HbA1c) levels to ≤6% in 150 obese diabetic
patients (mean age at baseline, 48; mean body-mass index at baseline,
36 kg/m2) at 1 year (NEJM JW Gen Med Mar 26 2012). Now, the
researchers present longer-term outcomes.
At 3 years, the proportions of patients whose HbA1c levels were ≤6%
and who no longer were taking diabetes medications remained
significantly higher in the gastric-bypass and sleeve-gastrectomy
groups than in the medical-treatment group (35% and 20% vs. 0%). On
standardized questionnaires that reflected eight quality-of-life
domains, scores improved significantly in five domains in the bypass
group, two domains in the gastrectomy group, and no domains in the
medical-treatment group. Four surgically treated patients required
additional surgical interventions to address complications within the
first year, but no patients required additional surgery thereafter.
Schauer PR et al., N Engl J Med 2014 Mar 31;