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Bariatric surgery moves forward

The use of bariatric surgery continues to rise, and its use in people with diabetes has expanded to the point where it is now called metabolic surgery, since it does not always involve people who are obese. Early claims of curing diabetes have changed to more reliable reports of putting type 2 diabets into remission. Through all of this growth and popularity however, there was a lack of randomized prospective trials. This deficit is now being met, and today in the New England Journal of Medicine, the STAMPEDE investigators released the 5 year follow-up on their randomized prospective trial comparing Roux-en-Y gastric bypass surgery, sleeve gastrectomy, and intensive medical treatment. Only 5% of those in the intensive medical treatment group had diabetes remission at 5 years, compared to 26% remission in the surgical groups. Sustained improvements in A1C, HDL cholesterol, triglycerides and of course weight were also present. Notably, 36% of participants had BMIs between 27-34, opening up a much larger prospective patient group for this treatment. Long-term side effects, including depression, are present, but the evidence supporting metabolic surgery continues to increase.

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