New NEJM Study Shows Bariatric Surgery Effective
for Treating Diabetes

Major News Media
Take Notice

Published in March 2014 Issue             

Major news media including USA Today, Reuters, LA Times and CBS News are today covering a new study from Cleveland Clinic that shows bariatric surgery is a highly effective and durable treatment for type 2 diabetes in patients with moderate and severe obesity, enabling nearly all surgical patients to be free of insulin and many to be free of all diabetic medications three years after surgery.

The STAMPEDE (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently) trial was simultaneously published in The New England Journal of Medicine and presented today at the Annual Scientific Session of the American College of Cardiology in
Washington, D.C.

The study followed 150 patients with diabetes: one-third was treated with medication and lifestyle changes; one-third also had gastric bypass; and the other third had
sleeve gastrectomy.

At the three-year mark, more patients in the gastric bypass group (37.5 percent) achieved blood sugar control without the use of any diabetic medications compared with the other two groups -- 5 percent of the patients in the medical therapy group and 24.5 percent of the patients in the sleeve gastrectomy group. This correlates with a weight loss five to six times greater on average for patients who had bariatric surgery compared with those in the intensive medical therapy group.

In USA Today, Dr. Philip Schauer commented, "At three years, the therapeutic gap — the difference between blood sugar in the surgical group and the medical group — got even larger in favor of surgery" than it had been at one year. Diabetes got worse in the group taking medications alone, as is typical with diabetic patients, said Schauer, whose study was presented today at the American College of Cardiology's annual conference in Washington, D.C., and appears in the NEJM.

The Associated Press quotes an independent expert, Dr. Robert Siegel, a cardiologist at Cedars-Sinai Medical Center in Los Angeles who says the results are “quite remarkable” and could revolutionize care. “No one dreamed, at least I didn’t that obesity surgery could have such broad effects long before it caused patients to lose weight.

A patient who had bariatric surgery five years ago and was taking drugs for diabetes, high blood pressure and high cholesterol is no longer taking any now. “It’s a miracle,” she said. “It saved my life. I have no doubt that I would have had serious complications from my diabetes” because, as she told the AP, the disease killed her mother and grandmothers at a young age.

Dr. Robert Ratner, chief scientific and medical officer for the American Diabetes Association, said he was “very encouraged” that so many stayed in the study and that it will be important to follow them even longer. He said, “we need to know about the cost and complications” of treatments, saying diets costs less and have fewer side effects.

Some stories noted the trial, known by the acronym STAMPEDE, also showed that the two types of surgery had fairly similar benefits, which was somewhat unexpected because gastric bypass has been around longer and was believed to be better.

Researchers noted more than 90 percent of the patients who had bariatric surgery were able to lose 25 percent of their body weight and control their diabetes without insulin and multiple diabetes drugs.

Also, bariatric surgery patients experienced an improvement in quality of life and a reduction in the need for cardiovascular medications to control blood pressure and cholesterol compared to those receiving medical therapy. As a result, patients in the surgery groups used less cardiovascular and glucose-lowering medications – 5 to 10 percent were on insulin compared to 55 percent of the patients in the medical therapy group. In addition, new data looked at kidney function, measured by the amount of albumin in the urine and a marker of kidney damage due to diabetes. Albumin level was significantly lower in the gastric bypass group only.