治疗糖尿病，微创手术完胜降糖药物强化治疗。

　　由美国ClevelandClinic的Schauer教授所领导的著名随机临床对照研究——STAMPEDETrial，比较减肥手术与药物强化治疗糖尿病与肥胖症的效果，历经五年随访，结果毫不意外，微创减肥手术治疗糖尿病和肥胖症，效果远远优于药物治疗。

　　经微创手术治疗，88%的糖尿病病人摆脱了胰岛素，术后五年，血糖仍然维持正常。术后血糖可否恢复，取决于体重减轻程度和糖尿病病程长短，如果病程小于8年，治疗效果优良。此外，微创手术治疗的病人，生活质量显著优于通过药物治疗的病人，且导致心、脑血管以外的风险因素，显著下降。不过，对于长期糖尿病所导致的视网膜病变和糖尿病肾病，手术治疗与药物治疗相比没有显著差别。

　　April4,2016

　　Inthefinal,five-yearfollow-upreportfromtheinfluentialSTAMPEDEtrial,ClevelandClinicresearchshowsthatbariatricsurgery'sbeneficialeffectsonbloodglucosecontrolinmildandmoderatelyobesepatientswithtype2diabetesmaypersistforuptofiveyears,withtheadvantageoverdiabetesmedications-onlyapproachwideningovertime.

　　Thefive-yearfollow-upalsoreportedthat:

　　Over88percentofgastricbypassandsleevegastrectomypatientsmaintainedhealthybloodglucoselevelswithouttheuseofinsulin.

　　29percentofgastricbypasspatientsand23percentofsleevegastrectomypatientsachievedandmaintainednormalbloodglucoselevels,comparedtojust5percentofthoseonmedicationalone.

　　Weightlosswassignificantlygreaterwithgastricbypassandsleevegastrectomythanwithmedicationsandwastheprimarydriverforglucosecontrol.

　　Theeffectsofbothsurgicalprocedurestonormalizeglucoselevelsdidhoweverdiminishovertimeandsomelatecomplicationswerenotedwithsurgery.

　　"Ourfindingsshowcontinueddurabilityofglycemiccontrolaftermetabolicsurgery,aswellaspersistentweightloss,reductionindiabetesandcardiovascularmedicationsatfiveyears,"saidPhilipSchauer,M.D.,leadauthorandClevelandClinicbariatricsurgeon,whopresentedtheresultstodayatACC.16,theAmericanCollegeofCardiology's65thAnnualScientificSession.

　　"Thesuperiorbenefitsofsurgerytoattaindiabetestreatmentgoalsmustbecarefullybalancedwiththelong-termrisksassociatedwithsurgeryforindividualpatients,"saidSangeetaKashyap,M.D.,co-investigatorinvolvedwiththetrialandanendocrinologistatClevelandClinic'sEndocrinology&MetabolismInstitute.

　　AccordingtotheCDC,29millionpeopleintheUnitedStates(9.3percent)havediabetes.Morethan70,000personsdieannuallyduetocomplicationsassociatedwithdiabetes,accordingtotheAmericanDiabetesAssociation.Approximately50percentofpatientscurrentlytreatedfortype2diabeteswithmedicationsarenotmeetingstandardtargetsofglycemiccontrolandthusareatriskfordevelopingcomplicationsofdiabetes.

　　"Leftunchecked,diabetescanleadtokidneyfailure,blindness,andlimbamputation,"saidDr.Kashyap."Atthefive-yearmark,bariatricsurgery'smetaboliceffectpersistsandismoreeffectiveattreatingtype2diabetesinmoderateandseverelyobesepatientswhencomparedtomedicaltherapy."

　　TheSTAMPEDE(SurgicalTherapyAndMedicationsPotentiallyEradicateDiabetesEfficiently)trialisthelargestrandomizedtrialwithoneofthelongestfollow-upscomparingmedicaltherapywithbariatricsurgery.

　　Thetrialinitiallyinvolved150overweightpatientswithpoorlycontrolleddiabetes.Thepatientsweredividedintothreegroups:1)Fiftypatientsreceivedintensivemedicaltherapyonly,includingcounselingandmedications;2)FiftypatientsunderwentRoux-en-Ygastricbypasssurgeryandreceivedmedicaltherapy;3)Fiftypatientsunderwentsleevegastrectomyandreceivedmedicaltherapy.

　　Effectivenesswasgaugedbythepercentageofpatientswhoachievedbloodsugarcontrol,definedinthisstudyashemoglobinHbA1cleveloflessthanorequalto6.0percent-amoreaggressivetargetthantheAmericanDiabetesAssociation'sguidelines.HbA1cisastandardlaboratorytestthatreflectsaveragebloodsugaroverthreemonths.

　　Findingsfromthefive-yearfollow-upconfirmthosefromtheone-yearandthree-yearreportsandincludethefollowing:

　　RatesofachievingandmaintaininganHbA1clevelof6.0percentorlessatfiveyearsweresignificantlyhigherwithgastricbypass(29percent)andsleevegastrectomy(23percent)thanwithintensivemedicaltherapyalone(5percent).

　　Weightlosswassignificantlygreaterwithgastricbypassandsleevegastrectomythanwithmedicaltherapy.

　　Useofcardiovascularandglucose-loweringmedications,includinginsulin,atfiveyearswassignificantlyreducedfrombaselineinbothsurgicalgroups,andwassignificantlylowerinthesurgicalgroupsthaninthemedicaltherapygroup.Over88percentofsurgicallytreatedpatientsmaintainedglycemiccontrolwithoutuseofinsulin.

　　Thefive-yearanalysisalsoyieldedseveralnewinsights,includingthefollowing:

　　Inthetwosurgicalgroups,achievingtheprimaryendpointofanHBA1clessthanorequalto?6.0percentwaspredictedbothbyareductioninbodymassindex(BMI)andadurationofdiabetesoflessthaneightyears.

　　Therewerenolatemajorcomplicationsofsurgeryexceptforonereoperation(asuccessfullaparoscopicconversionofsleevegastrectomytogastricbypassforrecurrentgastricfistula)fouryearsafterrandomization.

　　Significantanddurableimprovementsinbodilypainandgeneralhealthweredemonstratedusingavalidatedquality-of-lifeinstrumentinbothsurgicalgroupsrelativetothemedicalgroup.

　　Severalbiomarkersassociatedwithheightenedcardiovascularriskwerereducedinthesurgicalarms,buttherewerenobeneficialeffectsonretinopathyornephropathyseenat5years.

　　"Someadvantagesofgastricbypassoversleevegastrectomyhaveemergedduringfollow-up,"Dr.Schauersaid."Atfiveyears,gastricbypassmaintainedgreaterweightlossthansleevegastrecomywhilerequiringfewermedications."

　　HealsonotesthatthefinalSTAMPEDEresultsmighthelpexpandthepopulationofpatientsinwhombariatricsurgerymaybeconsideredforimprovingglycemiccontrol.

　　"MostclinicalguidelinesandinsurancepoliciesforbariatricsurgerylimitaccesstopatientswithaBMIof35orabove,"Dr.Schaueradded."Ourfive-yearresultsdemonstratethatglycemicimprovementinpatientswithaBMIof27to34isdurableatleastuptofiveyears."