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Martedì 01 Aprile 2014 12:14

At 3 years, glycemic control and quality of life were better with surgery than with medical management.

In a previously published report from a randomized Cleveland Clinic trial, Roux-en-Y gastric bypass and sleeve gastrectomy were more likely than medical therapy (42% and 37% vs. 12%) to lower glycosylated hemoglobin (HbA1c) levels to ≤6% in 150 obese diabetic patients (mean age at baseline, 48; mean body-mass index at baseline, 36 kg/m2) at 1 year (NEJM JW Gen Med Mar 26 2012). Now, the researchers present longer-term outcomes.

At 3 years, the proportions of patients whose HbA1c levels were ≤6% and who no longer were taking diabetes medications remained significantly higher in the gastric-bypass and sleeve-gastrectomy groups than in the medical-treatment group (35% and 20% vs. 0%). On standardized questionnaires that reflected eight quality-of-life domains, scores improved significantly in five domains in the bypass group, two domains in the gastrectomy group, and no domains in the medical-treatment group. Four surgically treated patients required additional surgical interventions to address complications within the first year, but no patients required additional surgery thereafter.

 

Comment

The key findings here are that the improved glycemic control reported after 1 year persisted at 3 years and that quality of life improved in the surgery groups. But even-longer-term outcomes, including diabetes end-organ complications and late gastrointestinal surgical complications, will be important to track.

 

 

Citation(s):

  1. Schauer PR et al. Bariatric surgery vs. intensive medical therapy for diabetes — 3-year outcomes. N Engl J Med 2014 Mar 31; [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMoa1401329)

Allan S. Brett, MD Reviewing Schauer PR et al., N Engl J Med 2014 Mar 31;