Positive Outcomes, Nearly a Decade After Surgery

gastric bypass diabetesSeveral recent studies have demonstrated the effectiveness of gastric bypass surgery in resolving diabetes in the short-run. Now, a new study found that almost a decade after weight loss surgery, patients continue to show significant improvements over their baseline diabetic status, glycemic control and cardiovascular risk. Eight-five percent of patients in the study met the goals set out by the American Diabetes Association (ADA) as much as nine years after undergoing weight loss surgery.

The findings did indicate that the long-term remission rates of type 2 diabetes were slightly lower than previously reported short term results: 20% of patients experienced diabetes recurrence after an initial remission. Lead study author Stacy Brethauer, MD, bariatric surgeon at the Cleveland Clinic, said “the study definitively shows that patients continue to experience markedly better diabetic control, improvements in diabetic nephropathy and control of cardiovascular risk factors compared with their pre-surgery status. Although some would consider the recurrence of diabetes a failure, our data and others must be measured against the known risks of poorly controlled diabetes in patients who do not undergo bariatric surgery.”

The study involved 217 patients with type 2 diabetes who had weight loss surgery from 2004-2007 and had at least five years of follow-up. Seventy-five percent of the patients had gastric bypass surgery, which is the procedure associated with the highest rates of weight loss and diabetic remission. There were not enough patients who had the gastric sleeve or Lap-Band to draw conclusions about long-term diabetic outcomes with these procedures.

The researchers found that at a median follow-up of six years, a quarter of bypass patients maintained complete remission of their type 2 diabetes, and another quarter had partial remission. An additional one third had improvements in their diabetic control. Bypass patients had much better glucose control after surgery, compared with the overall population of people being treated for type 2 diabetes in the United States. Approximately half of people with diabetes achieve the ADA’s therapeutic goal of A1c below 7%, according to the most recent data from the National Health and Nutrition Examination Survey. In comparison, 80% of all surgery patients met that goal at a median of six years after surgery, and 86% of gastric bypass patients. Although the success rates are quite high, there is still the approximately 20% of patients who have a relapse. In trying to predict which patients may be more likely to relapse, reseachers have found these factors can make a difference: having diabetes for a long duration, less weight loss initially, and greater weight regain in the long term. In addition to the benefits associated with diabetes remission, many patients also experienced lasting improvement in cholesterol levels and blood pressure.

Dr. Matthew Brengman, expert bariatric surgeon in Virginia, said “The Cleveland Clinic study represents an important missing link in the mounting information on surgical treatment of diabetes.  There are now several Level 1 randomized control trials (RTC) of surgical weight loss versus medical therapy in Diabetic patients (one from the same Cleveland Clinic authors).  These studies have shown the dramatic benefits of surgical weight loss over the medical management of diabetes.  Unfortunately, RTC are short-term studies due to the rigor and expense of conducting the trials.  Here we have the next step: confirmation that the dramatic short term benefit of surgical weight loss in the treatment of diabetes is sustained out to ten years.  This study shows surgical weight loss in the form of gastric bypass is definitively better than medical therapy over the long term.

Brengman added that another important highlight of this study is the fact that longer duration of diabetes prior to surgical intervention predicted a lessor benefit from surgery.  “This finding further emphasizes the importance of early intervention in patients with weight related diabetes to achieve a better long term result.  Hopefully, the recent declaration of obesity as a disease by the AMA will motivate primary care physicians to consider referral for bariatric surgery earlier in the course of diabetes,” he said.

Related Reading:  Gastric Bypass for Mildly Obese People with Diabetes

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