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Bariatric surgery reduces long-term need for insulin in type 2 diabetes
WASHINGTON — Adults with type 2 diabetes who require insulin treatment before undergoing bariatric surgery experience significant weight loss, and 44% no longer require insulin 5 or more years after surgery, study findings show.
Ali Aminian, MD, associate professor of surgery at the Cleveland Clinic Lerner College of Medicine, and colleagues evaluated 252 adults (64% women; mean age, 52 years; mean baseline BMI, 46 kg/m2) with insulin-treated type 2 diabetes (mean HbA1c, 8.5%; median duration of diabetes, 11 years) who underwent Roux-en-Y gastric bypass (RYGB; n = 194) or sleeve gastrectomy (n = 58) to determine the effects of bariatric surgery on long-term diabetes remission and long-term glycemic control.
HbA1c less than 6.5%, fasting blood glucose less than 126 mg/dL and no need for diabetes medication 5 or more years after surgery were used to define long-term diabetes remission; Hb1c less than 7% without insulin use for 5 or more years was used to define glycemic control without insulin use. Follow-up was between 5 and 12 years.
At a median of 7 years after surgery, BMI was reduced by a mean 11.2 kg/m2, and the reduction was associated with a decrease in mean HbA1c (1.5%; P < .001), fasting blood glucose (52.5 mg/dL; P < .001) and diabetes medication requirement (1; P < .001).
Compared with sleeve gastrectomy, RYGB was associated with greater decreases in BMI (7.8 kg/m2 vs. 12.2 kg/m2; P < .001) and number of diabetes medications (0.6 vs. 1.1; P = .01).
“Both procedures were associated with significant weight loss; however, RYGB was more powerful,” Aminian told Endocrine Today. “The patient could lose more weight after RYGB compared to sleeve gastrectomy. In terms of glycemic control, in the short term, RYGB was superior to sleeve gastrectomy, but in the long term, both procedures were comparable.”
More participants met the American Diabetes Association requirement of HbA1c less than 7% at the last follow-up (59%) compared with baseline (18%; P < .001). Fifteen percent of participants achieved long-term diabetes remission, and 44% achieved long-term glycemic control without insulin use.
On multivariate analysis, researchers observed that duration of diabetes before surgery and good glycemic control at baseline were both independent predictors of the study outcomes.
“We concluded that both procedures, RYGB and sleeve gastrectomy, can induce significant and sustainable improvements in cardiometabolic risk factors, including blood pressure and lipid profile and glycemic control, in patients with type 2 diabetes who were on insulin at the time of surgery,” Aminian said. – by Amber Cox
Reference:
Aminian A, et al. A110. Presented at: ObesityWeek 2017; Oct. 29-Nov. 2, 2017; Washington, D.C.
Disclosure: Aminian reports no relevant financial disclosures.
Perspective
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The implications of the study results from Aminian and colleagues are reinforcing what we already know. The study demonstrated that bariatric surgery is safe and effective, particularly in the long term. The other finding from the study is the sooner patients get treatment — just like for any other disease — they have better outcomes. The Roux-en-Y gastric bypass did better for type 2 diabetes treatment compared with the sleeve gastrectomy, particularly with higher weight patients.
What is nice about this study is that it’s pretty long term. A lot of the previous studies are only about 1 year, but there is a lot more evidence now to show that weight-loss surgery is persistent and enduring, and there have also been many randomized trials between medical therapy and surgical therapy demonstrating the benefits of surgical therapy in patients with obesity and diabetes. Those are sometimes patients that are hard to get those endpoints on because it is tougher to get glycemic control in those patients with obesity.