O Objetivo deste estudo foi avaliar a melhora do controle da diabetes tipo 2 com a cirurgia bariatrica, tanto a r-de-roux, quanto a sleeve, mais medicação, comparando com somente o uso de medicação.

Foram avaliados 150 pacientes por 12 meses, todos com diabetes diagnosticada pela hemoglobina glicada maior do que 6,5%, media de 9,2%.

O objetivo era a redução da hemoglobina glicada menor ou igual a 6,0%

Os resultados foram que a cirurgia em Y-de-roux obteve o melhor controle da diabetes e 42% deste grupo atingiu o objetivo proposto. Na sleeve, 37% alcançou o objetivo e 12% no uso somente de medicação. Estes dados mostram que as cirurgias bariatricas são superiores ao uso de medicação para o controle da diabetes tipo 2.

O uso de medicações contra pressão alta, diabetes e de redução de colesterol, diminuiu significativamente no grupo de cirurgias, mas aumentou no grupo do uso de medicação somente.

Não ocorreram mortes ou eventos morbidos significativos.

O estudo mostra a superioridade das cirurgias bariatricas, em especial a y-de-roux, sobre o uso de medicação para o controle da glicemia. Entretanto os autores ressaltam a necessidade de um estudo acima de 12 meses para avaliar a persistencia destes resultados.

Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes

Philip R. Schauer, M.D., Sangeeta R. Kashyap, M.D., Kathy Wolski, M.P.H., Stacy A. Brethauer, M.D., John P. Kirwan, Ph.D., Claire E. Pothier, M.P.H., Susan Thomas, R.N., Beth Abood, R.N., Steven E. Nissen, M.D., and Deepak L. Bhatt, M.D., M.P.H.

N Engl J Med 2012; 366:1567-1576April 26, 2012

Background

Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery.

Methods

In this randomized, nonblinded, single-center trial, we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The mean (±SD) age of the patients was 49±8 years, and 66% were women. The average glycated hemoglobin level was 9.2±1.5%. The primary end point was the proportion of patients with a glycated hemoglobin level of 6.0% or less 12 months after treatment.

Results

Of the 150 patients, 93% completed 12 months of follow-up. The proportion of patients with the primary end point was 12% (5 of 41 patients) in the medical-therapy group versus 42% (21 of 50 patients) in the gastric-bypass group (P=0.002) and 37% (18 of 49 patients) in the sleeve-gastrectomy group (P=0.008). Glycemic control improved in all three groups, with a mean glycated hemoglobin level of 7.5±1.8% in the medical-therapy group, 6.4±0.9% in the gastric-bypass group (P<0.001), and 6.6±1.0% in the sleeve-gastrectomy group (P=0.003). Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group (−29.4±9.0 kg and −25.1±8.5 kg, respectively) than in the medical-therapy group (−5.4±8.0 kg) (P<0.001 for both comparisons). The use of drugs to lower glucose, lipid, and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only. The index for homeostasis model assessment of insulin resistance (HOMA-IR) improved significantly after bariatric surgery. Four patients underwent reoperation. There were no deaths or life-threatening complications.

Conclusions

In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further studywill be necessary to assess the durability of these results. (Funded by Ethicon Endo-Surgery and others; ClinicalTrials.gov number, NCT00432809.) Supported by a grant (EES IIS 19900) from Ethicon Endo-Surgery, a grant (R01-DK089547) from the National Institutes of Health, and LifeScan

Vale ressaltar o conflito de interesses no site do artigo original no New England

http://www.nejm.org/doi/full/10.1056/NEJMoa1200225?query=TOC