Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes

Kashyap SR, Bhatt DL, Wolski, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care. 2013;36:2175-2182.

A1C improvement from baseline was seen in all treatment groups at 24 months in a metabolic substudy of the STAMPEDE trial.

A1C
Mean baseline A1C was 9.7%. At 24 months, mean A1C was 8.4% with intensive medical therapy (n=17), 6.7% with gastric bypass (n=18), and 7.1% with sleeve gastrectomy (n=19; P<0.05 for each surgical group vs medical therapy). In the surgical groups vs the medical therapy group:

  • Greater improvements seen in fasting plasma glucose, HDL-C, triglycerides, and high-sensitivity C-reactive protein
  • Lower percentage of subjects using insulin

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 13 - STAMPEDE Metabolic Substudy A1C Improvement
 

Weight loss, truncal fat
Greater weight loss was seen in both the gastric bypass and sleeve gastrectomy groups compared with medical therapy at 12 and 24 months. Reduction in body weight, body mass index, and absolute change in total body fat percent was similar between the gastric bypass and sleeve gastrectomy groups at 24 months. The absolute reduction in truncal fat from baseline was greater among those who underwent gastric bypass (-15.9%) compared with those who underwent sleeve gastrectomy
(-10.1%; P=0.04). 

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 14 - STAMPEDE Metabolic Substudy Greater Reduction
 

Insulin sensitivity, beta-cell function
Greater increases in insulin sensitivity and beta-cell function at 24 months were seen in the gastric bypass group. Insulin sensitivity (median) at 24 months vs baseline

  • Gastric bypass (n=9): 3.8 vs 1.4 (P<0.001) – 2.7-fold increase
  • Sleeve gastrectomy (n=10): 5.8 vs 5.3 – 1.2-fold increase
  • Medical therapy: no change

Beta-cell function (median absolute change) at 24 months vs baseline

  • Greater with gastric bypass vs medical therapy (oral disposition index): 0.196 vs 0.027 (P=0.001)
  • No difference between sleeve gastrectomy and medical therapy (oral disposition index): 0.058 vs 0.027 (P=0.30)
  • Median 5.8 fold-increase from baseline with gastric bypass; negligible increases in other groups
  • Inverse correlation seen with percentage of truncal fat and prandial free fatty acid levels

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15 - STAMPEDE Metabolic Substudy Greater Increases
  

About this study
This study, a 2-year extension of a metabolic substudy of the STAMPEDE trial, evaluated the effect on glucose regulation, beta-cell function, and body composition at 12 and 24 months of: intensive medical therapy, intensive medical therapy + Roux-en-Y gastric bypass, and intensive medical therapy + sleeve gastrectomy. Randomization was 1:1:1. Subjects (N=60) had uncontrolled type 2 diabetes (mean A1C 9.7%) and moderate obesity (average body mass index 36 kg/m2).
 

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16 - STAMPEDE Metabolic Substudy Design  

STAMPEDE=Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently 

Related content: 

Slide: STAMPEDE:Design 

Slide: STAMPEDE: Results: Primary Endpoint (A1C ≤6%) at 12 Months 
 

Overview: Bariatric surgery versus intensive medical therapy in obese patients with diabetes 

  

September 2013 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 8/4/2014