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A Surgical ‘Cure’ for Diabetes?

Bariatric surgery shows long-term positive effects for some obese patients with diabetes…. 

Previous studies have reported the successfulness and benefits of Roux-en-Y gastric bypass and other laparoscopic procedures but those studies examined the short-term and medium-term effects. A recent study published in the Annals of Surgery examined the long-term effects of bariatric surgery in obese patients with type 2 diabetes and found them to be substantial. In the retrospective review, Brethauer et al looked at 217 type 2 diabetic patients who underwent bariatric surgery and had at least five years of follow-up documentation, which included FBG levels, HbA1c levels and body weight.

Of the 217 patients, an estimated weight loss of 55% was associated with an estimated reduction in HbA1c from 7.5% to 6.5% and FBG from 155.9 mg/dL to 114.8 mg/dL (< .001). Additionally, 24% achieved complete remission and 26% achieved partial remission. Complete remission, as defined by the ADA, is HbA1c less than 6% and FBG less than 100 mg/dL, and partial remission is HbA1C of 6%-6.4% and FBG of 100-125 mg/dL; each for one year without the use of antidiabetic medications. Roux-en-Y gastric bypass, the most common procedure, showed almost a one-third rate of remission, and 27% of those patients maintained complete remission for more than five years. Furthermore, the amount of diabetic medications, including insulin, used by patients decreased; and the amount of patients who had not been taking any medications increased.

In addition to diabetes remission, the researchers also reported on improvements seen in cardiovascular risks and diabetic neuropathy. After surgery, 62% and 72% of patients were at goal for blood pressure and LDL levels, respectively; and 53% of those patients who initially reported diabetic neuropathy saw regression.

Overall, this study provided further confirmation that bariatric surgery is effective in allowing obese patients to obtain remission and improvement of type 2 diabetes. Additionally, the option of surgery provides patients the possibility of improving cardiovascular risks and other diseases related to diabetes, such as diabetic neuropathy.

Practice Pearls:
  • Higher estimated weight loss provides greater reduction in HbA1C and FBG
  • Close to one-third of obese patients in remission of diabetes after electing to have Roux-en-Y gastric bypass (RYGB) surgery
  • Improvements seen in cardiovascular risks and other comorbidities

Annals of Surgery, October 2013