Gastric bypass improved type 2 diabetes remission

Roux-en-Y gastric bypass surgery had metabolic benefits for insulin-dependent patients, according to recent study results presented at the 25th Annual Meeting of the American Society for Metabolic and Bariatric Surgery.

Researchers from Duke University Medical Center in Durham, N.C., conducted a retrospective, observational study evaluating the effects of surgery in a cohort of obese patients with type 2 diabetes who were insulin-dependent.

“Our goal was to evaluate factors that would predict the formation of type 2 diabetes in a more uniform study population,” said Brian Kadera, a medical student at the Duke University School of Medicine. “Previous study populations have focused on full-spectrum diabetes, with high rates of omission.”

According to an abstract, 1,546 obese patients undergoing Roux-en-Y gastric bypass were enrolled in the study between 2000 and 2006. Kadera said that 314 of these patients had diabetes, and 71 were insulin-dependent. Four patients with type 1 diabetes were excluded from the insulin-dependent cohort.

After separating the patients into quartiles based on their postoperative percent excess weight loss, a correlation between increased percent excess weight loss and increased rate of diabetes remission was observed, according to Kadera.

“Patients in this series had, at the very least, improvement,” he said. “Thirty-four patients — about half — had achieved remission of type 2 diabetes, and the other half achieved improvement.” – by Eric Raible

One of the drawbacks of the manuscript is that the researchers do not comment on the surgical technique of the gastric bypass. I am sure that with such a large number of procedures by a variety of surgeons during multiple years, the technique varied. There may be confounding variables that may contribute to weight loss outcome differences. The question remains: Did these surgical variations in technique lead to possible differences in metabolic manipulations that ultimately led to differences in weight loss and hence differences in subsequent remission rates?

– Shanu N. Kothari, MD, FACS

Director, Minimally Invasive Bariatric Surgery

Gundersen Lutheran Medical Center, La Crosse, Wis.

For more information:
Kadera B. Is Roux-en-Y gastric bypass for type 2 diabetes mellitus really metabolic surgery? The importance of the bariatric impact of surgery. #PL-01. Presented at: The 25th Annual Meeting of the American Society for Metabolic and Bariatric Surgery; June 15-20, 2008; Washington D.C.