1. Philip R. Schauer, M.D., Deepak L. Bhatt, M.D., M.P.H., John P. Kirwan, Ph.D., Kathy Wolski, M.P.H., Stacy A. Brethauer, M.D., Sankar D. Navaneethan, M.D., M.P.H., Ali Aminian, M.D., Claire E. Pothier, M.P.H., Esther S.H. Kim, M.D., M.P.H., Steven E. Nissen, M.D., and Sangeeta R. Kashyap, M.D. N Engl J Med March 31, 2014 Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes R4 김진숙 / Prof. 오승준

2. Introduction Bariatric surgery - R-Y gastric bypass, Sleeve gastrectomy, Gastric banding … - Recently emerged as a potentially useful Tx. for T2DM : significantly improve glycemic control & favorably affect cardiovascular risk factors

3. Introduction Bariatric surgery - Questions remain regarding the durability of the Metabolic benefits of surgery, Long-term safety, QOL, and Effects on DM-related end-organ disease  Report provides results of the 3-yr follow-up analyses from the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial

4. Methods Study design - March 2007 ~ January 2011 - 150 obese patients, single-center (Cleveland clinic) - 3 groups, randomized, controlled Eligibility criteria - Age of 20~60yrs - A diagnosis of T2DM (glycated hemoglobin >7.0%) - BMI of 27~43 Exclusion criteria - Undergone previous bariatric surgery or other complex abd.surgery - Poorly controlled medical or psychiatric disorders

5. Methods Study outcomes - Primary outcome : glycated hemoglobin ≤ 6.0% with or without the use of diabetes medications - 3-year outcomes : glycemic control, weight loss, blood pressure, lipid levels, renal function, carotid intima–media thickness, medication use, adverse events, disease-related complications, and quality of life

6. Results

7. 150 patients (March 2007~January 2011) 9 patients : withdrew 4 patients : f/u loss 137 patients

10. Figure 1. Mean Changes in Measures of Diabetes Control from Baseline to 3 Years.

12. Figure 2. Polar Chart of Scores for Quality of Life at Baseline and 3 Years after Randomization.

13. P <0.05 No excessive weight loss or hypoalbuminemia No life-threatening complications or deaths in any of the groups

14. Conclusion Obese patients with uncontrolled T2DM Favorable results at 3years - Glycemic control - Body weight - Use of glucose-lowering medications - Quality of life Intensive medical therapy + Bariatric surgery Intensive medical therapy only >