(RxWiki News) For obese diabetes patients, surgery to lose weight has become an increasingly popular way to improve their health. Some have experienced long-term remission and reduced their medication use.
Several studies have shown that obese patients may have better results controlling their diabetes with weight surgery than with exercise, diet or medication. Long-term outcomes, however, have been mixed.
A new investigation found that some patients who have had surgery may reduce or eliminate their diabetes for years after their operation.
"If you're obese, investigate gastric bypass to treat diabetes."
Stacy Brethauer, MD, a bariatric surgeon at the Cleveland Clinic Bariatric & Metabolic Institute, and colleagues analyzed information on 217 type 2 diabetes patients who had surgery to reduce their weight.
The subjects, who were followed for at least five years, were categorized in one of three groups — 162 patients who had gastric bypass surgery, 32 who had a gastric banding procedure done and 23 who underwent sleeve gastrectomy.
A gastric bypass is one of the most common types of weight loss, or bariatric, surgeries. The operation limits the amount of food a person can eat. In a typical bypass, a stomach pouch may be created out of a small portion of the stomach and attached directly to the small intestine, bypassing a large part of the stomach and duodenum.
With gastric banding, a surgeon inserts a band around the upper part of the stomach to create a small pouch to hold food. With sleeve gastrectomy, the patient has about 85 percent of the stomach surgically removed.
After a median follow-up point of six years after their bariatric surgery, about half of patients had experienced diabetes remission. Remission means that blood sugar has been lowered to healthy levels.
Blood sugar is often measured by two blood tests. An HbA1c test shows the average amount of sugar in the blood over the previous two to three months. A fasting blood glucose (FBG) test measures blood sugar after several hours without food.
About a quarter of patients in this study maintained complete remission without taking medication, meaning they kept an HbA1C level of less than 6 percent and an FBG of less than 100 milligrams per deciliter.
Another quarter of patients had partial remission — they maintained an HbA1c of 6 percent to 6.4 percent and an FBG of 100 to 125 milligrams per deciliter for one year without taking diabetes medications.
The American Diabetes Association advises an HbA1c target level of 7 percent. An FBG between 70 and 100 milligrams per deciliter is considered normal.
The authors of this study noted that about one third of patients overall had better diabetes control after bariatric surgery. The number of patients requiring insulin therapy in the long term dropped by about 50 percent. Also, individuals who had surgery significantly lowered their risk of heart problems.
The researchers said that those who had the best results — the highest rates of long-term remission — were those who had gastric bypass surgery compared to gastric banding, those who kept weight off long-term and those who had diabetes less than five years before surgery.
Some patients continued to improve or reverse their diabetes up to nine years after their procedure.
Although bariatric surgery may not be a remedy for everyone, the loss of weight appears to have definite health benefits, and it may be most effective in treating patients whose diabetes is not very advanced.
“This study confirms that the procedure can offer durable remission of diabetes in some patients and should be considered as an earlier treatment option for patients with uncontrolled diabetes," Dr. Brethauer said in a press release.
This research appears in the October issue of the journal Annals of Surgery. Dr. Brethauer is a consultant and speaker for Ethicon Endo-Surgery and a speaker for Covidien.
