U.S. Department of Health and Human Services

Bariatric Surgery Reduces Blood Glucose Levels

 A recent study has shown that bariatric surgery can help control type 2 diabetes more effectively than medical therapy alone, and can help reduce the need for medications to lower glucose, lipids, and blood pressure. To understand the potential health benefits of bariatric surgery for people with obesity and poorly controlled type 2 diabetes, researchers compared outcomes achieved through intensive medical therapy (which included lifestyle counseling, weight management programs, frequent home glucose monitoring, and the use of diabetes medications) to those obtained with intensive medical therapy in combination with bariatric surgery. Of the many available forms of bariatric surgery, researchers tested two specific procedures: a variation of gastric bypass surgery, called Roux-en-Y surgery, in which the top portion of the stomach is connected directly to a lower portion of the small intestine; and sleeve gastrectomy, in which the majority of the stomach is removed, leaving a comparatively narrow “sleeve.” After 12 months, blood glucose was reduced to levels below the diabetic range in only 12 percent of participants that received medical therapy alone, compared to 42 percent in the gastric bypass group and 37 percent in the sleeve gastrectomy group. Indeed, many of the patients in the two surgery groups who achieved these good glucose levels within a year of surgery did so without further use of diabetes medications. Overall, the use of medications to treat cholesterol and blood pressure, as well as to lower blood glucose levels, decreased sharply in both surgical procedure groups, whereas medication use modestly increased in the group that was given medical therapy alone. Longer studies will be needed to determine whether the metabolic improvements observed in the surgery patients will be durable. Further, determining whether these results apply equally to various racial/ ethnic groups with obesity and type 2 diabetes will require a larger study, with a more diverse cohort. However, this study adds to existing evidence that bariatric surgery may be a reasonable approach for treating some patients with obesity and uncontrolled type 2 diabetes.

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366: 1567-1576, 2012.