A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/69304
Articles 10 and 11 BARIATRIC SURGERY VERSUS CONVENTIONAL MEDICAL THERAPY FOR TYPE 2 DIABETES CITATION Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–1585. PURPOSE OF THE STUDY The purpose of this study is to compare two types of bariatric procedures (gastric bypass and biliopancreatic diversion) with conventional medical therapy for the treatment of type 2 diabetes mellitus (T2MD) in patients with severe obesity. METHODS Seventy-two patients were enrolled into this single-center, nonblinded, randomized, controlled study at the Day Hospital of Metabolic Diseases and Diabetology of the Catholic University in Rome between April 2009 and October 2011. Inclusion criteria for the study was as follows: patients ages 30–60, a BMI of 35kg/m2 or more, a history of T2DM of at least five years, a glycated hemoglobin level of 7.0% or more, and an ability to understand and adhere to the study protocol. Of the 72 patients, 60 patients were randomly assigned to 1 of 3 study groups: gastric bypass, biliopancreatic diversion, or medical therapy. Twenty patients were included in each group. RESULTS Two patients in the medical therapy group discontinued the study; 1 patient in each surgical group also discontinued study. Results at 2 year follow-up include the following: • No diabetes remission occurred in the medical therapy group, 75% had diabetes remission in the gastric bypass group, and 95% in the biliopancreatic diversion group. • Average percent changes in glycated hemoglobin levels from the baseline value were smaller in the medical therapy group (8.65%±1.45%) compared to the gastric bypass (-8.39%±9.93%) and biliopancreatic diversion group (-25.18±20.89%). • Changes in fasting plasma glucose levels also had a similar trend as the glycated hemoglobin levels: medical therapy (-14.37%), gastric bypass (-37.81%), and biliopancreatic diversion (-56.23%). • Surgical groups experienced greater weight loss and BMI reduction from baseline than the medical therapy group. • Systolic and diastolic blood pressures were significantly reduced in all three groups. • There were no operative deaths. • Complications of surgical procedures include incisional hernia (1 patient in biliopancreatic group), intestinal occlusion (1 patient in gastric bypass group), iron- deficiency anemia (2 patients in each group), hypoalbuminemia (1 patient in each group), osteopenia (1 patient in biliopancreatic group), and osteoporosis (1 patient in biliopancreatic group). CONCLUSION Bariatric surgery, specifically gastric bypass and biliopancreatic diversion, is more effective than conventional medical therapy in controlling comorbidities, such as T2DM in patients with severe patients. BARIATRIC SURGERY VERSUS INTENSIVE MEDICAL THERAPY IN OBESE PATIENTS WITH DIABETES CITATION Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in patients with obesity with diabetes. N Engl J Med. 2012;366(17):1567–1576. PURPOSE OF THE STUDY The purpose of this study is to compare intensive medical therapy with surgical treatment (gastric bypass or sleeve gastrectomy) in improving 22S Bariatric Times • June 2012 • Supplement glycemic control in patients with obesity with T2DM. METHODS From March 2007 through January 2011, 150 patients were enrolled into this randomized, nonblinded, single- center study. Patients were randomly assigned to undergo intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Eligibility criteria included patients ages 20–60 years old, a diagnosis of type 2 diabetes (glycated hemoglobin level at >7%) and a BMI of 27–43kg/m2 . RESULTS Eight patients withdrew from the study during the first year of follow up and 2 patients missed follow-up visits at 9 months and 12 months, leaving 140 patients who completed the study.