Scientists from Catholic University of Rome recently published results of their studies in „The Lancet”. They proved that bariatric surgeries are more effective in treatment of diabetes type 2 in obese patients than pharmacotherapy.
Obesity is a chronic disease in which excess body fat has accumulated to the extent (BMI≥30 kg/m2 ) that it may cause lower quality of life, disability and risk of premature death. Obesity is considered as the main cause of diabetes type 2 in patients with genetic predispositions. One method of obesity treatment is bariatric surgery, which should be considered as a treatment option for patients with a BMI≥40 kg/ m2 or a BMI≥35 kg/ m2 with intercurrent disease related to obesity. Surgical procedures can be divided into restrictive, which reduce oral intake by limiting gastric volume or malabsorptive such as biliopancreatic diversion, which cause malabsorption of nutrients. There are also mixed procedures such as gastric bypass surgery, also known as Roux-en-Y gastric bypass.
Scientists from Catholic University of Rome enrolled to their studies 60 patients, aged 30-60 years with a BMI≥35 kg/m2 and a history of type 2 diabetes lasting at least 5 years and glycated haemaglobin A1c (HbA1c) concentration of ≥7,0% or more. Patients were randomly assigned (1:1:1) into three groups. First group received medical treatment (glucose-lowering drugs and insulin dosage were optimised on an individual need of each patient) and lifestyle modification recommendations (diet and exercises were planned by diabetologists and dietitians). Second group received biliopancreatic diversion surgery, third group received Roux-en-Y gastric bypass surgery. At the outset surgical groups also were receiving medical treatment, due to hyperglycaemia and high level of glycated haemaglobin A1c (HbA1c) concentration.
53 (88%) patients completed 5 year’s follow-up. After 5 years nobody from medically treated group maintained diabetes remission compared to 19 (50%) patients from surgical group. Diabetes remission was maintained by 7 out of 19 patients (37%) from Roux-en-Y bypass group and 12 out of 19 (63%) patients from biliopancreatic diversion group. Irrespective of remission, 4 (27%)medically treated patients, 8 (42%) given Roux-en-Y bypass and 13 (68%) given biliopancreatic diversion achieved level of glycated haemaglobin A1c (HbA1c) concentration ≤ 6,5%. 33 (87%) surgical patients did not requiered medication for hyperglycaemia for the duration of the study. 18 (47%) surgical patients required insulin at the begining of the study; all but one of those patients were no longer taking insulin at the end of the study. By contrast, in the medical group, insulin use increased. During the study, in the medical group 4 (27%) patients developed diabetes complications, including one fatal myocardial infarction. Only 1 (5%) patient given Roux-en-Y surgery developed nephropathy and none of patients given biliopancreatic diversion surgery developed diabetes complications.
br/>In conclusion, scientists from Catholic University of Rome proved that bariatric surgery is more effective than medical therapy in treatment of diabetes type 2 in obese patients. Those results may affect the treatment algorithm for the management of diabetes type 2 in the future. Nevertheless, further studies are needed to assess long-term health effects.
Written by: Magdalena Rejmak, Karolina Lewczuk, Mateusz Puchala
Source:
1) G. Mingrone, S. Panunzi, A. De Gaetano, C. Guidone, A. Iaconelli, G. Nanni, M. Castagneto, S. Bornstein, F. Rubino, Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386: 964–73
2) Chirurgia, red. Noszczyk W., 2014.
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