26th Annual Meeting of the American Society for Metabolic and Bariatric Surgery
The positive, long-term impact on the resolution of type 2 diabetes
following bariatric surgery was confirmed in two studies presented at the
26th Annual Meeting of the American Society for Metabolic and Bariatric
This is a strong message to physicians and endocrinologists that
gastric banding should be very seriously considered in the morbidly obese
diabetic population because it offers the best chance to have better control or
remission of their diabetes long-term, Christine Ren, MD,
associate professor of surgery at New York University School of Medicine, told
Ren and colleagues gathered preoperative data on 95 patients (mean age,
49.3) who underwent laparoscopic adjustable gastric banding between 2002 and
2004. Five-year follow-up data were collected beginning in 2008.
At the five-year follow-up, mean BMI decreased from 46.3 to 35.0
a mean value of 48.3% excess weight-loss.
There was a sustained benefit about 40% of patients had
complete remission in their diabetes. This was confirmed with normal fasting
blood sugar, normal HbA1c and they were completely off all medications
including insulin, Ren said. In addition, there were another 40% of
patients who had improvements in diabetes as shown by a decrease in their
medication, improvements in fasting blood glucose control and improveents in
HbA1c. Diabetes was resolved in 43% of patients, for a total
improvement/resolution rate of 83%.
About 88% of patients were taking antidiabetes therapies before the
procedure, which decreased to about 47% at the five-year follow-up. In
addition, about 15% of patients were using insulin preoperatively, and use
decreased to about 9% at follow-up.
Mean fasting glucose decreased from 146 mg/dL preoperatively to 118.5
mg/dL at five years; mean HbA1c decreased from 7.53% to 6.58%
Diabetes-free five to 16 years following surgery
In another study, researchers from Virginia Commonwealth University
examined 177 patients (147 females) with diabetes who underwent Roux-en-Y
gastric bypass surgery between 1993 and 2003. Follow-up was between five and 16
Patients were divided into three groups based upon treatment prior to
surgery: insulin dependent (n=59), oral medication (n=83) and diet and
lifestyle intervention only (n=35).
Complete resolution was achieved in 157 patients who also had a decrease
in mean BMI from 50.2 before surgery to 31.3 after surgery. Forty-three percent
of these patients subsequently had type 2 diabetes recurrence and associated
weight gain. Twenty patients did not achieve complete resolution of type 2
diabetes despite mean excess weight of 58.2% (P<.0009).
Patients controlled on diet or oral medication before surgery were 10
times as likely as insulin-controlled patients with diabetes to have a durable
remission (.5 years).
When looking at the insulin-controlled diabetic patients, 80% had
resolution at some point, but recurred in 72%, James W. Maher, MD,
professor of surgery at the University, said during an interview. The
durability of resolution seems to correlate inversely with the severity of the
disease insulin-dependent diabetics were most likely to have recurrence
and patients who initially underwent dietary control were very likely to have a
long-term positive result.
There are a lot of data out there that gastric bypass improves
type 2 diabetes and we certainly noticed that in our own patients, but we also
noticed that over time it seemed to come back in at least some of them,
he said. So, if the physician has a candidate for weight-loss surgery to
treat diabetes, it should come early in the course of their disease. If they
get to the point of insulin dependence they may have a pancreas that does not
have very much reserve in the insulin producing cells and therefore a long-term
remission may not be achieved. by Jennifer Southall
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