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Bariatric surgery offers metabolic benefits for obese patients with diabetes
Obese bariatric surgery recipients with type 2 diabetes experienced improved glycemic control and pancreatic beta-cell function compared with medical therapy recipients in a recent study.
In a substudy of the STAMPEDE trial, researchers evaluated the body composition and beta-cell function of 60 moderately obese (BMI, 36 ± 2 kg/m2) patients with uncontrolled type 2 diabetes. Participants had been randomly assigned to receive either intensive medical therapy (IMT) with Roux-en-Y gastric bypass (GB), IMT with sleeve gastrectomy (SG) or IMT alone.
The mean HbA1c at baseline was 9.7% ± 1%. All three groups experienced improved glycemic control at 24 months, which was greater in the surgery groups (mean HbA1c=8.4% ± 2.3%, IMT group; 6.7% ± 1.2%, GB group; 7.1% ± 0.8%, SG group; P<.05 for both comparisons).
The surgery groups experienced similar reductions in weight, BMI and total body fat percentage, but the absolute reduction in truncal fat was larger among GB recipients (16% decrease vs. 10% SG; P=.04). Investigators also noted that insulin sensitivity among noninsulin-users increased in the GB group (3.8 vs. 1.4; P<.001), but did not change significantly in the other groups.
Patients in the GB group experienced a median 5.8-fold increase in pancreatic beta-cell function, with no significant increase in the other groups. At 24 months, absolute change in beta-cell function was greater in the GB group compared with those who received IMT alone (P=.001), but not in the SG group compared with IMT (P=.3).
Multivariate analysis indicated an association between increased truncal fat and reduced likelihood of glycemic control at 24 months (OR=0.878; 95% CI, 0.777-0.991), while an increase in beta-cell function was associated with increased probability of control (OR=1.67; 95% CI, 1.012-1.124).
“Bariatric surgery induces powerful metabolic effects in moderately obese patients with advanced type 2 diabetes inadequately controlled with currently available drug therapy,” the researchers concluded. “Bariatric surgery, particularly gastric bypass surgery, uniquely restores normal glucose tolerance and pancreatic beta-cell function. Longer-term multicenter studies with safety outcomes are warranted to test the durability of these metabolic benefits.”
Disclosure: See the study for a full list of relevant disclosures.