This article is more than 5 years old. Information may no longer be current.
Diabetes remission rate higher after gastric bypass vs. medical therapy
Click Here to Manage Email Alerts
Adults with type 2 diabetes who undergo gastric bypass surgery are more likely to experience disease remission compared with those who undergo conventional medical therapy, particularly when they have a lower baseline HbA1c and shorter disease duration, according to research in Diabetes Care.
In an analysis of three separate studies comparing four gastric bypass procedures and medical therapy in terms of type 2 diabetes remission rates, researchers also found that more patients achieved remission after either Roux-en-Y gastric bypass or biliopancreatic diversion vs. gastric banding procedures, despite gastric diversion patients having a longer diabetes duration at baseline and worse glycemic control.
“Overall, the best predictors of improvement in glycemic control after bariatric surgery were smaller waist circumference, better-controlled diabetes, and lower triglyceride levels at baseline,” Simona Panunzi, PhD, of the CNR Institute for Systems Analysis and Computer Science, BioMatLab, Rome, and colleagues wrote. “In addition, responders lost more weight and waist circumference after bariatric surgery, had a greater reduction in plasma triglycerides and became more insulin sensitive.”
Panunzi and colleagues analyzed data from 727 adults with type 2 diabetes (415 bariatric surgery patients; 312 medical therapy patients) participating in three studies: the Swedish Obese Subjects study, examining diabetes status 10 years after bariatric surgery; and two randomized controlled studies, both comparing gastric banding vs. conventional medical therapy. Patients participating in the three studies underwent vertical banded gastroplasty (n = 227), gastric banding (n = 91), Roux-en-Y gastric bypass (n = 77) and biliopancreatic diversion (n = 20); researchers divided patients into gastric-only and gastric-with-diversion groups.
Researchers found that 63.7% of patients in the surgical arm achieved diabetes remission, defined as a fasting blood glucose of 5.6 mmol/L or less without pharmacologic therapy, compared with 15% in the medical arm (P < .001). The gastric-with-diversion group achieved a higher remission rate vs. the gastric-only group (76% vs. 60%; P = .016). In multivariable models, shorter diabetes duration, lower fasting blood glucose and not taking diabetes drugs at baseline predicted a higher probability of diabetes remission at 2 years. Patients in remission lost more weight (25% vs. 17%) and waist circumference (18% vs. 13%) than those without remission and also experienced better insulin sensitivity.
“Furthermore, the effect of bariatric surgery on diabetes remission seems to be independent of baseline BMI, suggesting that bariatric surgery could be a therapeutic option for patients with [type 2 diabetes] and abdominal obesity, even with BMI between 30 [kg/m²] and 35 kg/m²,” the researchers wrote. – by Regina Schaffer
Disclosure: Panunzi reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts