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Factors Impacting Diabetes Remission and Glycemic Control Following Bariatric Surgery

Study finds remission rates of diabetes in patients who undergo weight loss procedure.

Bariatric surgery has been associated with the remission of diabetes. A prospective, controlled Swedish Obese Subjects (SOS) study showed a 72% remission rate compared with 21% in subjects treated with conventional weight loss. Bariatric surgical procedures can either reduce the amount of food the stomach can hold, cause malabsorption of nutrients, or a combination of both, which results in weight loss. There have been several different randomized controlled studies on bariatric surgery and diabetes remission showing remission rates ranging from 37% up to 95%. However, these studies have differences in the criteria used to define diabetes remission, baseline patient characteristics, surgical therapy, and duration of follow-up. These differing factors from different studies make it hard to determine the factors impacting their diabetes remission.

Usually, only patients with a BMI greater than or equal to 35 with uncontrolled diabetes were considered potential candidates for bariatric and metabolic surgery. The International Diabetes Federation made an official statement in 2011 stating that surgery is only indicated for patients with a BMI greater than 40. For those whose BMI falls between 35-40, surgery should be considered if their A1c is not below 7.5% even after conventional medical therapy and lifestyle changes options. However, BMI is not a reliable measurement for diagnosis and BMI as a selection condition for bariatric surgery for type 2 diabetes treatment has been shown not to predict outcome.

A recent study aimed to look specifically at the different factors impacting diabetes remission and assess predictors of remission. The study looked at patients with diabetes whose BMI is greater than 35 with poorly controlled glycemia. A total of 727 patients were identified in the study with 415 surgical patients and 312 medical patients. The surgical group was divided further into gastric only and gastric plus diversion group.

Gastric bypass is considered the gold standard for weight loss and restricts the amount of food the stomach can hold. Gastric plus diversion is more complicated, but the food is diverted and roughly three-fourths of the small intestine is bypassed resulting in greater weight loss. The results of the study found that 64% of patients in the surgical group and 15% of the patients in the medical group experienced diabetes remission. More specifically in the surgical group, gastric only had 60% remission compared to 76% remission of gastric plus diversion. Not only did the gastric plus diversion group show higher remission, the group also showed greater weight loss. The study also showed that those who had remission of diabetes lost more weight, waist circumference, and experienced better insulin sensitivity than those who didn’t.

There were several factors found by the study that affected the rates of remission. Patients with shorter diabetes duration, lower fasting blood glucose before surgery, and type of operation (gastric only or gastric plus diversion) showed higher rates of remission. The study also found that baseline A1c and waist circumference were indicators for improved glycemic control. The results of diabetes remission also appear to be independent of baseline BMI, suggesting that bariatric surgery could be a therapeutic option for patients with diabetes and abdominal obesity even if their BMI is between 30 to 35.

Practice Pearls:

  • Bariatric surgery has been shown to cause remission of diabetes through weight loss. Remission rates can range from 37% up to 95%.
  • The study found that patients with shorter diabetes duration, lower fasting blood glucose before surgery, and type of operation (gastric only or gastric plus diversion) showed higher rates of remission.
  • Baseline A1c and waist circumference were found as indicators of improved glycemic control post-surgery.
  • The results from the study indicate that remission is independent of baseline BMI suggesting bariatric surgery could be a therapeutic option for patients with diabetes.

Researched and prepared by Samantha Ferguson, Doctor of Pharmacy Candidate University of FAMU College of Pharmacy

 

Panunzi, Simona, et al. “Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery.” Diabetes care 39.1 (2016): 166-174.

American Society for Metabolic and Bariatric Surgery. “Bariatric Surgery Procedures.” www.asmbs.org

Sjöström L, Lindroos AK, Peltonen M, et al.; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–2693