Type II DM Control after Bariatric Surgery (1)

Type II diabetes is currently one of the fastest growing epidemics in known human history. It is generally agreed to be closely associated with obesity, with various clinical manifestations. Besides, multiple risks factors are involved in the causation of diabetes.
Moreover, diabetes has a progressive nature with no cure at present. Disease control is performed by continuous monitoring and re-assessment of diabetic management measures.
Prognosis of the disease usually leads to intensification of therapy with increasing dose of OHA, including insulin, according to the generally accepted algorithms provided by American Diabetes Association. [1]


ADA diabetes treatment algorithms suggested lifestyle modification for patients at risk of diabetes. Once patients are diagnosed, metformin mono-therapy is the recommended first line treatment, followed by additional second-line medications if HbA1C target levels has not been achieved. Eventually, it will be the use of insulin.


The application of bariatric surgery in diabetic control has been studied and its effectiveness is compared against conventional treatment, such as intensive medication therapy. Patients seemed significantly benefited from bariatric surgeries in combination with medication therapy.


Bariatric surgery VS intensive medication therapy - STAMPEDE Trial (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently)

In a randomized, non-blinded, one-center trial, the efficacy of intensive medication treatment was compared with the combination of medication and bariatric surgery, either Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrollable type 2 diabetes. The primary end point of the trial was the proportion of patients with glycated hemoglobin level (HbA1c) 6.0% or less at 12 months after treatment. Moreover, change in fasting plasma glucose, average numbers of diabetes medications and change in BMI were the second end points of the trial.


It is concluded that 12 months of combined treatment of medication and bariatric surgery could significantly achieve glycemic control than medication alone, as only 12% of patients were able to reach the first end point, versus 42% in the gastric bypass group and 37% in the sleeve-gastrectomy group. The results of the other end points were shown in Figure 1.





(Figure 1)

 

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.