Percentage of weight loss after bariatric surgery predicts diabetes remission
A 20% weight-loss threshold after bariatric surgery is associated with initial type 2 diabetes remission, even among patients with a high BMI using insulin, data from a records review show.
In an analysis of electronic health records within the Kaiser Permanente Southern California health care system, researchers found that weight loss after bariatric surgery is strongly associated with initial type 2 diabetes remission; however, rates of initial diabetes remission did not increase substantially above a threshold of 20% total weight loss.
“Even if patients with diabetes have conditions at surgery that make it hard for them to benefit fully from the intervention, like a BMI of 50 kg/m2 or more and being on insulin, they still derive similar benefits for their diabetes from surgery as people who do not have these conditions as long as they lose 20% of their body weight,” Karen J. Coleman, PhD, MS, a research scientist in the division of health services research at Kaiser Permanente Southern California, told Healio.
Coleman and colleagues analyzed EHR data from 5,928 patients with type 2 diabetes who underwent sleeve gastrectomy (n = 2,546) or Roux-en-Y gastric bypass surgery (n = 3,382) between 2009 and 2016 (mean age, 50 years; 73% women; mean baseline BMI, 43.8 kg/m2). The primary outcome was type 2 diabetes remission, determined at least 90 days after surgery or stopping all diabetes medication. Researchers used Cox proportional hazards models to assess the relationship between initial type 2 diabetes remission and percent total weight loss after bariatric surgery, with categories of percentage of total weight loss included in the model as time-varying covariates.
During a mean 5.9 years of follow-up, 71% of patients experienced initial remission of type 2 diabetes, with a mean time to remission of 1 year.
With 0% to 5% total weight loss used as the reference group, researchers found patients were more likely to remit with each 5% increase in total weight loss until 20% total weight loss, with an HR range of 1.97 to 2.92.
When categories above 25% total weight loss were examined, all patients had a likelihood of initial remission comparable with total weight loss of 20% to 25%. Patients who achieved greater than 20% total weight loss were more likely to achieve initial type 2 diabetes remission than patients with 0% to 5% total weight loss, even if they were using insulin at the time of surgery.
“We want physicians to understand that they need to have more reasonable expectations of weight loss with surgery and that these reasonable expectations still result in profound improvements in cardiovascular risk, death and quality of life,” Coleman told Healio. “Even though patients prescribed insulin experienced benefits from surgery, physicians should not wait to recommend bariatric surgery as a last resort. Patients do better if they are healthier going into surgery. Bariatric surgery is by far the most effective long-term treatment we have for severe obesity, and we should be treating it as a secondary prevention strategy.”
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Karen J. Coleman, PhD, MS, can be reached at email@example.com.