Surgery vs. Medication? Which is better?

This study aimed to compare the effects of bariatric surgery compared to medication in type 2 diabetes.

Type 2 diabetes is a long-term, progressive disease caused due to resistance to insulin. There are several ways to treat this disease, including surgery and medication. In obese patients, bariatric surgery is often recommended and there are two main types of surgery: gastric bypass and sleeve gastrectomy.

Gastric bypass surgery helps the patient lose weight by changing how the stomach and small intestine handle the food eaten. The stomach is divided into two sections; a small and large section. Food passes into the small section, making the patient feel fuller, faster. This section is attached directly to the small intestine, meaning the body will absorb fewer calories. Sleeve gastrectomy helps with weight loss. The surgeon removes a large portion of the stomach; typically the stomach size is reduced to 25% of the original.  It limits the amount of food that is eaten, making the patient feel full after eating small amounts of food.

Although bariatric surgery has been associated with superior short-term outcomes in achieving glycemic (blood glucose) control compared to medication, longer-term outcomes are lacking.

The study evaluated 150 patients followed over 3 years. These patients were divided into three groups. One group received intensive medical treatment (40 patients), another received gastric bypass (48 patients) and the last group received a sleeve gastrectomy (49 patients). The study focused on the percentage of each group that achieved an HbA1c level of < 6%. HbA1c is a measurement of average blood glucose levels over the past 3 months.

At the end of 3 years, the study found that only 5% of the patients on medication alone had achieved their HbA1c goal, while 38% of those who received gastric bypass and 24% of those who received sleeve gastrectomy achieved their HbA1c goal. The study also found that the average percentage of body weight reduction was much higher with gastric bypass (24.5%) and sleeve gastrectomy (21.1%) compared to medical therapy (8.3%). The study found that the overall quality of life was significantly higher in the surgery groups compared to the medication group.

This study found that patients with uncontrolled type 2 diabetes who underwent surgery had a much better blood sugar control than patients who only received medical therapy.

The study only looked at the effects of bariatric surgery over 3 years. Longer term effects of bariatric surgery on type 2 diabetes are unknown.

Consult with your doctor on whether bariatric surgery may be an alternative to medical therapy.