The increasing incidence of obesity brings a parallel increase in type 2 diabetes (T2D), a metabolic complication of excess body weight. Despite recent improvements in pharmacotherapy, T2D symptoms are not normalised in up to 50% of patients, meaning a continued high risk of additional serious complications. Bariatric surgery, which involves the removal or re-routing of parts of the stomach and/or intestine, is known to provide significant weight-loss in the morbidly obese. However, whether these procedures can improve uncontrolled T2D, particularly in moderately obese individuals, has been unclear. Now, Schauer et al. report the first controlled trial comparing the results of bariatric surgery with medication versus medication alone in obese subjects with uncontrolled T2D. After 12 months, patients that underwent bariatric surgery had lost more weight and had decreased their medication use, whereas those receiving medication alone had lost very little weight and had increased their medication use. Although glycaemic control improved in all groups, 42% of those in the surgery cohort had normalised blood glucose, compared with only 12% in the medication alone group. Although larger studies will be needed to assess long-term outcomes, this study suggests that bariatric surgery combined with medication is a promising therapy for obese individuals with T2D.

SchauerP. R., KashyapS. R., WolskiK., BrethauerS. A., KirwanJ. P., PothierC. E., ThomasS., AboodB., NissenS. E., BhattD. L. (2012). Bariatric surgery versus intensive medical therapy in obese patients with diabetes. New Engl. J. Med.366, 15671576.

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