Gastric Bypass Resolves More Than 80% of Cases of Type 2 Diabet

Fasting plasma glucose and glycated hemoglobin concentrations normalized in 83% of patients and improved dramatically in 17%. Laparoscopic Roux-en Y gastric bypass results in substantial weight loss and resolves more than 80% of cases of type 2 diabetes, according to the results of a study published in the October issue of the Annals of Surgery. The investigators suggest that this bariatric operation should be considered the standard of care for morbidly obese type 2 diabetics.

"Most patients in the study with type 2 diabetes who underwent bypass surgery achieved excellent biochemical glycemic control and were able to reap the clinical benefits of withdrawing from most, if not all, antidiabetes medications, including insulin," Philip Schauer, MD, from the University of Pittsburgh in Pennsylvania, says in a news release. "Younger diabetes patients with less severe disease stand to gain more from the surgery by circumventing years of progressive, debilitating disease."

At the University of Pittsburgh Medical Center between 1997 and 2002, 1,160 patients underwent Roux-en Y gastric bypass surgery (LGBP), including 240 patients with elevated fasting glucose and type 2 diabetes. In 191 (80%) of these patients who were available for follow-up, mean age at surgery was 48 years (range, 26-67 years) and mean body mass index (BMI) was 50.1 kg/m2. Seventy-five percent of patients were female; 65% required oral hypoglycemic agents and 27% also required insulin.
Twenty months after surgery, mean excess weight loss was 60% and mean BMI was 34 kg/m2. Fasting plasma glucose and glycated hemoglobin concentrations normalized in 83% of patients and improved dramatically in 17%. Significant decrease in use of oral antidiabetic agents was possible in 80% of patients, and 79% required less insulin.

Although all patients had clinical resolution or improvement in diabetes, those with the shortest duration (less than five years) and with diet-controlled type 2 diabetes had a higher rate of resolution after surgery. During 310 patient-years of follow-up, there were no new occurrences or recurrences of type 2 diabetes. Nearly one third of patients permanently discontinued antidiabetic medications after hospital discharge, even before they could experience significant weight loss.

"The impressive effect of bypass surgery on morbidly obese patients with type 2 diabetes raises an argument for lowering the threshold for surgical intervention to moderate or mild obesity," Dr. Schauer says. "Further investigation demonstrating risk versus benefit for patients with moderate obesity is warranted." Ann Surg. 2003;238:467-485