by Colin Kenny, GP, Dromore
In the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial, 150 participants were randomised into three groups: intensive medical therapy only, intensive medical therapy plus Roux-en-Y gastric bypass, or intensive medical therapy plus sleeve gastrectomy. The individuals recruited were aged 41–57 years and were mildly to moderately obese; 68% were female. The average baseline HbA1c was 78 mmol/mol (9.3%).
The surgical groups showed greater improvement in metabolic syndrome components including BMI, waist circumference, triglycerides and HDL-cholesterol, compared with those receiving medical therapy alone.
The investigators concluded that surgical options were superior to standard intensive medical therapy at the 3-year mark. The medically treated group showed an initial improvement in glycaemic control within the first year, but were back to baseline by year three. This longer-term outcome study suggests that surgical procedures to improve blood glucose have shown better results over 3 years than using hypoglycaemic agents to improve glucose control, and, in spite of lower drug use, surgical treatments can improve kidney function, weight loss and blood pressure.
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