Patients report long-term favorable effects of weight loss surgery in
their daily lives
Significant weight loss and insulin independence drive improvement in
general health measures for patients with typediabetes

Date:
July 27, 2021
Source:
Cleveland Clinic
Summary:
A new study shows that over the course of five years, patients
who had bariatric and metabolic surgery to treat uncontrolled
type 2 diabetes reported greater physical health, more energy,
less body pain, and less negative effects of diabetes in their
daily lives, compared with patients who had medical therapy alone
for their diabetes.



FULL STORY ==========================================================================
A new analysis from the STAMPEDE trial shows that over the course of
five years, patients who had bariatric and metabolic surgery to treat uncontrolled type 2 diabetes reported greater physical health, more
energy, less body pain, and less negative effects of diabetes in their
daily lives, compared with patients who had medical therapy alone for
their diabetes.


========================================================================== Long-term changes in psychosocial and emotional quality of life measures
were not significantly different between the surgical and medical
groups. The research was published in the Annals of Surgery.

"Chronic diseases, such as severe obesity and diabetes, can negatively
affect quality of life," said Ali Aminian, M.D., director of Cleveland
Clinic's Bariatric & Metabolic Institute and lead author of the
study. "It is important to study the effects of different treatments
on the well-being of patients in their daily lives." The Cleveland
Clinic-led STAMPEDE study (Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently) was the first randomized controlled
clinical trial that compared head-to-head bariatric surgery with intensive medical therapy for the treatment of type 2 diabetes in patients with
poorly controlled diabetes and obesity.

The trial initially involved 150 participants, who were divided into
three groups: 1) Fifty patients received intensive medical therapy only, including counseling and medications; 2) Fifty patients underwent
Roux-en-Y gastric bypass surgery and received medical therapy; 3)
Fifty patients underwent sleeve gastrectomy and received medical
therapy. Effectiveness was gauged by the percentage of patients who
achieved blood sugar control, defined in this study as HbA1c level of
less than or equal to 6.0 percent -- a more aggressive target than the
American Diabetes Association's guidelines. HbA1c is a standard laboratory
test that reflects average blood sugar over three months.

The study's initial results showed that metabolic surgery is superior
to medical therapy alone for achieving weight loss and diabetes control
with less reliance on anti-diabetic medications. The five-year results
showed that the benefits of metabolic surgery persist over time.



==========================================================================
This current study looked at 104 STAMPEDE trial participants: 1)
Twenty-six patients who received intensive medical therapy only; 2)
Forty-one patients who underwent Roux-en-Y gastric bypass surgery and
received medical therapy; 3) Thirty-seven patients who underwent sleeve gastrectomy and received medical therapy.

The 104 patients were asked to answer two generic health-related quality
of life questionnaires (the RAND 36-Item Health Survey and European QoL
5- Dimensions) and a diabetes-specific questionnaire at the beginning of
the trial, and then on an annual basis following enrollment. Those three questionnaires were chosen to assess how surgical or medical treatment
of obesity and diabetes may affect key elements of quality of life.

The results show that over the course of five years, the 78 patients
in the surgical groups had significantly better scores on physical
functioning, more energy, less body pain, and improved general heath
scores compared with the 26 patients in the medical therapy group. The
diabetes questionnaire looked at 12 various aspects of life in patients
who have type 2 diabetes, such as maintaining a diet, going on vacation, planning meals or eating out with others, and family life. Over five
years, data show that diabetes has less negative impact on quality of life
in the metabolic surgery groups compared with the medical therapy group.

"Patients with long duration of diabetes tend to have poor quality of
life, especially when they develop microvascular complications like
eye and kidney diseases," said Sangeeta Kashyap, M.D., co-investigator
involved with the trial and an endocrinologist at Cleveland Clinic's Endocrinology & Metabolism Institute. "When diabetes is coupled with
obesity, the impact on lower quality of life can be related to the
mechanical effects of obesity as well, which leads to poor mobility and
bodily pain. Significant weight loss and insulin independence following metabolic surgery drive the improvement in general health measures and
quality of life for patients with type 2 diabetes," said Dr. Kashyap.

"Our findings suggest that psychological well?being needs may require
more attention in metabolic surgical patients," said Dr. Aminian. "As
part of our multidisciplinary approach to weight management at Cleveland Clinic, our patients have appointments with psychologists before and after surgery. The study results highlight that we may need greater emphasis
on that aspect of the treatment, such as identification of psychosocial
and emotional factors before surgery that can predict outcomes of surgery,
as well as continuous psychosocial support after surgery." More long-term research is needed to continue to gather feedback directly from patients
on the effects of metabolic surgery on their quality of life.

The STAMPEDE trial was financially supported by Ethicon, with additional support from LifeScan, Cleveland Clinic, and the National Institutes
of Health.

The sponsors had no role in the accrual or analysis of the data or in
the preparation of this manuscript.

========================================================================== Story Source: Materials provided by Cleveland_Clinic. Note: Content may
be edited for style and length.


========================================================================== Journal Reference:
1. Ali Aminian, Sangeeta R. Kashyap, Kathy E. Wolski, Stacy
A. Brethauer,
John P. Kirwan, Steven E. Nissen, Deepak L. Bhatt, Philip
R. Schauer.

Patient Reported Outcomes after Metabolic Surgery Versus Medical
Therapy for Diabetes. Annals of Surgery, 2021; Publish Ahead of
Print DOI: 10.1097/SLA.0000000000005003 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/07/210727171635.htm

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