Type II DM Control after Bariatric Surgery (2)

Bariatric surgery VS conventional medical therapy [3]

In another randomized, single-center, non-blinded, controlled trial, 60 patients with BMI over 35, a history of type II diabetes for over 5 years and HbA1c level over 7.0% were given either conventional mediation therapy or bariatric surgery. Two types of bariatric surgery were selected in the trial, which are gastric bypass and biliopancreatic diversion. The rate of remission of diabetes after 2 years was selected as the primary end point of the trial, defined as fasting blood glucose level less than 5.6mmol/L and HbA1c level less than 6.5% without the use of medication.

After two years of follow-up, bariatric surgery had resulted in better glycemic control than medication therapy alone. For the primary end point, one of the patients in the medical therapy group had any diabetes remission, compared with 75% in gastric bypass group and 95% in the biliopancreatic-diversion group. (Figure 2) Also, the average glycated hemoglobin level had decreased in all groups, though surgical groups had the most significant degree of improvement.



(Figure 2)

 

 

Efficacy of bariatric surgery

As reported in a meta-analysis published in 2004, bariatric surgery is shown to be effective for the majority of morbidly obese patients in terms of weight loss, as well as resolving or achieving complete resolution in obesity related co-morbidities, such as diabetes, hyperlipidemia, hypertension and obstructive sleep apnea.

The effectiveness of bariatric surgery has received recognition in the medical field. The International Diabetes Federation had recommended physicians to include bariatric surgery in the treatment plan for obese patients with type II diabetes and BMI over 35, or as a treatment option for those BMI ranged 30-35 in uncontrolled type II diabetics. On the other hand, recommended BMI should be lowered by 2.5 for Asians due to strong genetic predisposition.

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

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