Bariatric weight loss surgery linked with remission in diabetics

1. Weight loss surgery was associated with a higher rate of sustained diabetes remission than standard care with lifestyle modification and pharmacotherapy. 

2. Weight loss surgery was also associated with lower rates of microvascular and macrovascular complications of diabetes. 

Evidence Rating Level: 2 (Good)

Study Rundown: Obesity is an important risk factor for type 2 diabetes mellitus.  Previous studies have demonstrated that weight loss surgery can reduce the rate of subsequent diabetes, but the effect of weight loss surgery on long-term diabetes remission is less well understood.  This study followed 343 individuals with diabetes who had weight loss surgery for a median of 10 years to determine whether they achieved long-term diabetes remission. Individuals undergoing surgery in this study had a statistically significant lower rate of diabetes at 2, 10, and 15 years after surgery.  People who had diabetes for a shorter interval before surgery were more likely to experience remission.  The surgery group had fewer microvascular and macrovascular diabetes complications over the 20 years follow-up period.

This study included a large sample size and long follow-up period.  However, blood testing during the follow-up period was infrequent.  Moreover, additional blood testing beyond fasting glucose, such as hemoglobin A1c may have been useful.  While the control group was well-matched on most characteristics, those in the control group demonstrated lower BMIs, blood pressures, and serum insulin levels.  This study suggests that weight loss surgery may be useful in achieving diabetes remission and decreasing the vascular consequences of diabetes, but large randomized control trials must be done before weight loss surgery becomes a standard therapeutic option.

Click to read the study, published today in JAMA

Relevant Reading: Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects

In-Depth [prospective cohort]: This study followed 343 individuals for a median of 10 years with diabetes who underwent weight loss surgery to assess diabetes remission and risk of microvascular and macrovascular complications. Diabetes was defined based on blood glucose levels and the need for diabetes medications, while remission was defined based on blood glucose levels below the diabetic threshold and no need for pharmacotherapy.  Hospitalization or death from vascular complications of diabetes affecting end-organs (eg. eyes, kidneys, heart, brain) was also recorded. Individuals in the surgery group were more likely to be in diabetes remission at 2, 10, and 15 years (OR=13.3 (95% CI 8.5-20.7), p<0.001; OR=5.3 (95% CI 2.9-9.8), p<0.001; OR=6.3 (95% CI 2.1-18.9), p=0.001, respectively).  Short diabetes duration was associated with a higher rate of remission at 2 years (p<0.001) and lower relapse rate between years 2 and 10 (p=0.03).  Weight loss surgery was associated with lower rates of microvascular complications (log-rank p<0.001) and macrovascular complications (p=0.001) over a 20-year time period.

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