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Podcast: Bariatric Surgery Bests Medical Therapy Alone in Obese Patients with Diabetes


Bariatric surgery nearly cures type 2 diabetes-at least that’s what results of a new study, presented at the recent ACC meeting, seem to imply.

Bariatric surgery nearly cures type 2 diabetes-at least that’s what results of a new study seem to imply. The study, presented at the recent American College of Cardiology meeting and published in the New England Journal of Medicine, found that among 150 patients with type 2 diabetes and average BMI of greater than 27, 42% of those randomly assigned to the stomach-reducing surgery quickly reached blood sugar targets and remained controlled at 1-year follow-up.

What’s more, the use of medications to reduce glucose, lipid, and blood-pressure levels decreased significantly after both surgical procedures, but increased slightly in patients receiving medical therapy only. There were no severe complications.

What do the study results tell us about medical management of type 2 diabetes? What are the dangers, if any, associated with bariatric procedures? And, which patients with type 2 diabetes would be candidates for these procedures?

Here to put this issue into perspective are Drs. Deepak Bhatt, Christopher Cannon, and Payal Kohli. Dr Bhatt is chief of cardiology for the VA Boston Healthcare System, a senior investigator with the TIMI Study Group, and associate professor of medicine at Harvard Medical School. Dr Cannon, a senior investigator with the TIMI Study Group, editor-in-chief of Cardiosource Science and Quality, and a professor of medicine at Harvard Medical School. He is also an associate physician in the Cardiovascular Division of Brigham and Woman’s Hospital in Boston. Dr. Kohli graduated from Harvard Medical School and completed her internal medicine training in Boston and is scheduled to start her fellowship in cardiovascular medicine at the University of California San Francisco in June 2012.

Bariatric Surgery and Type 2 Diabetes

Take-home Points

• Bariatric surgery in overweight and obese diabetic patients significantly improved glycemic control at 1 year compared with optimal medical therapy alone.

• The beneficial effect was observed soon after surgery, even before the full degree of weight loss was manifest.

• Patients undergoing bariatric surgery had a significant reduction in the need for diabetes medications, as well as cardiovascular medications.

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. March 26, 2012. Epub ahead of print. Available at http://www.nejm.org/doi/full/10.1056/NEJMoa1200225

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