January 08, 2020
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Bariatric surgery leads to greater weight loss, diabetes remission irrespective of procedure type

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Carlos K.H. Wong

Chinese adults with obesity and type 2 diabetes lose more weight and are more likely to achieve diabetes and dyslipidemia remission at 5 years when treated with bariatric surgery than with nonsurgical options, with similar effectiveness for bypass and restrictive procedures, according to findings published in Diabetes/Metabolism Research and Reviews.

“This study is the largest cohort study that evaluated the effectiveness of bariatric surgery among Chinese population by using population-based data,” Carlos K.H. Wong, PhD, assistant professor in the department of family medicine and primary care at the Li Ka Shing Faculty of Medicine of the University of Hong Kong, told Healio. “Apart from prevalent and cumulative disease remission rates after bariatric surgery, this study provided attrition-adjusted disease remission rates to facilitate comparisons across comparative studies.”

Wong and colleagues assessed HbA1c, fating glucose, blood pressure, HDL cholesterol, LDL cholesterol, BMI and body weight in a 5-year follow-up period using data from the Hospital Authority Clinical Management System collected from 2006 to 2017. The researchers assessed the data from 401 adults with obesity and type 2 diabetes who had bariatric surgery (mean age, 53.36 years; 50.1% women; mean BMI, 36.81 kg/m2) and compared these data with those of a matched cohort of 1,894 adults with obesity and type 2 diabetes who did not have surgery (mean age, 53.28 years; 47.6% women; mean BMI, 36.31 kg/m2). The researchers assessed data at 3-month intervals during the first year after surgery and then annually for the remaining years of the study.

Operating room surgery 
Chinese adults with obesity and type 2 diabetes lose more weight and are more likely to achieve diabetes and dyslipidemia remission at 5 years when treated with bariatric surgery than with nonsurgical options, with similar effectiveness for bypass and restrictive procedures.
Source: Adobe Stock

Diabetes remission

Participants who sustained an HbA1c of 6% or lower for 1 year or more were considered to be in diabetes remission whereas an Hba1c between 6% and 6.5% for 1 year or more was considered partial remission.

According to the researchers, 18.6% of the surgical group achieved prevalent diabetes complete remission at 5 years vs. 3.5% for those in the nonsurgical group (P < .001). Among the surgical group, 22.1% achieved prevalent diabetes complete or partial remission at 5 years vs. 5.4% of nonsurgical group (P < .001). A greater proportion of surgical group participants had cumulative diabetes complete remission (25.6% vs. 3.8%) and cumulative diabetes complete or partial remission (32.6% vs. 7.7%) at 5 years (P < .001 both), and the findings for prevalent and cumulative remission held when incorporating attrition as an adjustment.

In addition, the researchers found that 60% of the surgical group reduced their HbA1c to below 7% at 5 years vs. 44.3% of the nonsurgical group (P = .014), and the “mean HbA1c of surgical patients at each follow-up point was significantly lower than that of their counterparts.”

Effects on lipids, weight

If a participant sustained LDL cholesterol levels below 4.14 mmol/L and triglyceride levels below 2.26 mmol/L with HDL cholesterol levels of at least 1.03 mmol/L for 1 year or more, the researchers considered them to be in dyslipidemia remission. According to the researchers, a greater proportion of the surgical group achieved prevalent dyslipidemia remission (21% vs. 6.1%) and complete dyslipidemia remission (40.3% vs. 14.2%) at 5 years compared with the nonsurgical group (P < .001 for all), and these findings held when incorporating attrition as an adjustment.

There was a mean 15.7% reduction in weight at 5 years for the surgical group vs. a 3.7% reduction for the nonsurgical group (P < .001), with the researchers noting that BMI of the nonsurgical patients “was significantly higher than surgical patients [at] each time point” and that “the percentage of excess weight loss of nonsurgical patients increased slowly, but were significantly lower than that of surgical patients over time.”

When comparing different surgery types, the researchers observed that bypass surgeries were performed for 91 participants and restrictive surgeries were performed for 310 participants, and effectiveness was similar for both types.

“The effectiveness of restrictive and bypass surgeries were compared,” Wong said. “These results can help bariatric surgeons in choosing a suitable surgery for patients.” – by Phil Neuffer

For more information:

Carlos K.H. Wong, PhD, can be reached at carlosho@hku.hk.

Disclosures: The authors report no relevant financial disclosures.

Editor's Note: This article was updated on January 9 to include more specific data on diabetes and dyslipidemia remission rates.