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This article originally posted and appeared in  Public HealthSurgeryIssue 654

Gastric Bypass Surgery Doesn't Cure Diabetes

Information coming from the largest community-based study of long-term diabetes outcomes after gastric bypass surgery shows that for mostpeople in the study, diabetes either never remitted after gastric surgery or relapsed within five years....
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After gastric bypass surgery, diabetes goes away for some people often even before they lose much weight. So does that mean gastric surgery "cures" diabetes? Not necessarily, according to the largest community-based study of long-term diabetes outcomes after bariatric surgery.

Among the two thirds of the study's patients whose diabetes at first went away, more than a third re-developed diabetes again within five years after gastric surgery. After adding in the one quarter of patients whose diabetes never remitted after surgery, most (56 percent) of the study's patients had no long-lasting remission of their diabetes following gastric surgery. However, when diabetes did go away, the research team extrapolated, it stayed away for a median of eight years.

Principal investigator David E. Arterburn, MD, MPH, a general internist and associate investigator at Group Health Research Institute answered the question, which kinds of obese people with type 2 diabetes are likely to get the most benefit from gastric surgery? "Our results suggest that, after gastric surgery, diabetes stays away for longer in those people whose diabetes was less severe and at an earlier stage at the time of surgery." "Gastric surgery isn't for everyone," he said. "But this evidence suggests that, once you have diabetes and are severely obese, you should strongly consider it, even though it doesn't seem to be a cure for most patients."

The multi-site study tracked 4,434 adults at Kaiser Permanente Northern California, Kaiser Permanente Southern California, and HealthPartners for 14 years: from 1995 to 2008. The research arms of all three of these integrated health care delivery systems -- and Group Health Research Institute, where the study's results were analyzed -- belong to the HMO Research Network. The patients had type 2 diabetes that was either controlled with medication or else uncontrolled, and they were also obese enough to be candidates for gastric bypass surgery.

"Diabetes is an increasingly common disease that tends to keep getting worse relentlessly," Dr. Arterburn said. More than 25 million American adults have diabetes - and as populations age and keep gaining weight, 50 million are predicted to have it by 2050. Already, diabetes accounts for 5 percent of all U.S. health care spending.

Dr. Arterburn added, "Our study is the first major evidence that diabetes often recurs after gastric bypass surgery." Still, he added, even after diabetes comes back, having had a long period of post-surgery remission is likely to have many positive effects, such as fewer complications of diabetes: less damage to eyes and kidneys, and fewer heart attacks, strokes, and deaths.

It's still not clear whether diabetes relapse happens because of gaining weight back or because of underlying the progression of diabetes. But patients' weight - before and after surgery - was not strongly correlated with remission or relapse of diabetes in this population.

Obesity Surgery, In Advance of Print, Dec. 2012 

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This article originally posted 29 November, 2012 and appeared in  Public HealthSurgeryIssue 654

Past five issues: Diabetes Clinical Mastery Series Issue 211 | Issue 751 | Humulin Insulin Special Edition October 2014 | Diabetes Clinical Mastery Series Issue 210 | Issue 750 |

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