Which is better, 1) Diet, exercise, and optimal medical therapy or 2) Gastric bypass or biliopancreatic diversion? An Italian study reported in the New England Journal of Medicine and summarized in July 5th issue of medscape endocrinology compared two groups of similar 43 year olds who had Diabetes Type 2 diagnosed 6 years prior to the onset of the study. They followed the two groups for two years. The remission rate, defined by a fasting sugar <100, and an A1C<6.5 on no medication was zero in the first group while 15 our of 20 patients in the surgical group met this criteria. Cholesterol levels were normalized in 27% of the first group and 100% of the surgical group. Blood pressure was improved in 70% of the first group and 80-85% of the surgical group.
comment- While numbers to not lie, I would like to see studies conducted on larger groups of patients with wider variation in age with detailed risk benefit analysis for all groups. I also am anxious to see the results as patients are followed for longer periods of time. The results obtained with biliopancreatic diversion are superior to those with bypass, but the complication rate is also higher.
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