Bariatric surgery is more effective than medical treatment alone for the long-term control of type 2 diabetes in obese patients, finds the first 5-year follow-up study, prompting a call for a rethinking of the diabetes care pathway with more emphasis on surgery.
Overall, 50% of patients who underwent surgery showed sustained remission of type 2 diabetes (defined as HbA1c less than 6.5%) without any medication upon 5-year follow-up, compared with none in the medically treated group.
"These people had nondiabetic glycemia for 5 years without ever taking a single antidiabetic drug," said Francesco Rubino, MD, senior author of the study and chair of bariatric and metabolic surgery at King's College London, United Kingdom.
And over 80% of surgically treated patients maintained the American Diabetes Association's (ADA's) treatment goal of HbA1c concentration below 7.0%, with just diet and/or metformin.
"This is a spectacular result," added Dr Rubino, although he acknowledged that the study involved only a small number of patients and was conducted at a single center.
The results were published in the September 5 issue of theLancet by Geltrude Mingrone, MD, of the Catholic University of the Sacred Heart, Rome, Italy, and colleagues, including Dr Rubino.
Like Cancer Treatment, Surgery Should Be Option in Diabetes
In an accompanying editorial, two other bariatric surgeons, Dimitri Pournaras, PhD, MRCS, and Carel le Roux, MBChB, PhD, both from Imperial College London, United Kingdom, draw a parallel with multimodal cancer treatment, where the best surgical treatment combined with the best medical treatment is better than either alone.
"This model could be followed for diabetes, with use of best medical care to maintain remission, which is often only possible with surgery," they write.
They suggest that future randomized controlled trials should assess the optimal point at which to use surgery, but that "all surgical groups should receive intensive medical treatment and close follow-up at some stage because, as [Dr] Mingrone and colleagues have now shown, not doing so results in relapse of diabetes."
Dr Rubino concurred, noting that the management of type 2 diabetes could come to resemble that of cardiovascular disease, with treatments ranging from diet and exercise, to drugs, to endoluminal stents or surgical bypass.
"Introducing surgical treatment in diabetes management allows escalation" of therapies according to disease severity and enables risk stratification, he told Medscape Medical News in an interview.
"If you know that surgery is an option, you give diet and drugs a reasonable time to work; if they fail, surgery should be considered," he added.
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