Which Is a Better Treatment Option for Type 2 Diabetes: Heart Surgery or Medication?

At the American Diabetes Association 69th Scientific Sessions, researchers presented their results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) study, which evaluated patients diagnosed with type 2 diabetes and stable heart disease. With more than 20 million Americans living with both diseases, Sheryl F. Kelsey, PhD, principal investigator and professor of epidemiology at the University of Pittsburgh Graduate School of Public Health, said, “We began this study because we don’t know how best to treat this deadly duo that is affecting more and more people at increasingly younger ages.”

The 2,368 patients who participated in the study were randomized into two groups: Group 1 received drug therapy plus prompt revascularization to restore blood flow and Group 2 received drug therapy alone. The two diabetes drug treatment strategies were also evaluated to determine which “resulted in better outcomes.”

After reviewing the data, the researchers learned the following:

• The five-year survival rates did not differ significantly between the revascularization group (88.3%) and the drug therapy group (87.8%).

• There was no significant difference in survival between those who received insulin-providing drugs (87.9%) and those who received insulin-sensitizing drugs (88.2%).

• The group that received bypass surgery was significantly lower compared (22.4%) to those who received drug therapy alone (30.5%).

Based on the results, the researchers concluded that there was “no difference in mortality among patients with type 2 diabetes and stable heart disease who received prompt bypass surgery or angioplasty compared to drug therapy alone.” They also learned that although “prompt bypass in patients with more severe heart disease did not lower mortality, it lowered their risk of subsequent major cardiac events.”

“Overall, the BARI 2D results reassure us that our current major drug treatments for diabetes are equally appropriate,” said Saul Genuth, MD, director of the diabetes management center of BARI 2D and professor of medicine as Case Western Reserve University. “They also indicate that when a patient with type 2 diabetes has more severe heart disease it may be better to do bypass surgery early than to wait and simply treat with medication. For patients with milder disease who are candidates for angioplasty, it is appropriate to treat with drug therapy first.”