Diabetes diminishes weight-loss effect of bariatric surgery
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Adults with obesity but without type 2 diabetes before undergoing bariatric surgery are 1.5 times more likely to achieve both a BMI less than 30 kg/m² and excess body weight loss of 50% or more compared with similar adults who have diabetes, according to findings accepted for presentation at the Endocrine Society Annual Meeting.
“We do know that, even with medical weight loss, people with diabetes do worse compared with people without diabetes,” Elif A. Oral, MD, MS, professor in the division of metabolism, endocrinology and diabetes at the University of Michigan, told Healio after a presentation to the press on Monday. “It could be the establishment of diabetes changes something permanently, perhaps in the hypothalamus, perhaps in the target tissues, such as brown fat or muscle. The short answer is we don’t know, but there are quite a few possibilities, and it may be commonly shared in all settings of weight loss. It will be interesting to tease that out.”
In a retrospective study, Oral, Ying-ying Luo, MD, a doctoral student in the division of metabolism, endocrinology and diabetes at the University of Michigan, and colleagues analyzed data from 714 adults participating in the Michigan Bariatric Surgery Cohort, a group of adults with a BMI of at least 35 kg/m² with comorbidities or a BMI of at least 40 kg/m² with no comorbidities. Participants underwent Roux-en-Y gastric bypass (n = 380; 80.3% women; mean age, 44 years; mean BMI, 47.3 kg/m²; 39.2% with type 2 diabetes) or sleeve gastrectomy (n = 334; 77.5% women; mean age, 45 years; mean BMI, 49.9 kg/m²; 32.3% with type 2 diabetes) at the University of Michigan between January 2008 and November 2013. Researchers used generalized linear mixed model analysis to compare the probability of achieving a BMI less than 30 kg/m² or achieving excess body weight loss of 50% or more based on type 2 diabetes status.
“We then further tested the effect of presence of diabetes for BMI outcomes across time using linear mixed model analysis,” the researchers wrote in an abstract. “Finally, we conducted a linear mixed model analysis to determine if diabetes is a predictor of future weight loss, percentage of total weight loss or percentage of excess weight loss over 5 years of follow-up.”
Researchers found that the presence of diabetes at baseline did not affect the probability of achieving a BMI less than 30 kg/m² (P = .0848); however, diabetes status “substantially” affected the probability of achieving 50% or more excess body weight loss (P = .0021). Adults without type 2 diabetes were 1.6 times more likely to achieve 50% or more excess body weight loss compared with those with type 2 diabetes (OR = 1.56; 95% CI, 1.18-2.08).
Additionally, type 2 diabetes status at baseline modified BMI points lost, regardless of the surgery type (P = .0178). The presence of diabetes at baseline diminished weight loss by 1.2 BMI points (95% CI, 0.21-2.2), which is 10% to 15% of the total BMI points lost, according to researchers. Results persisted in linear mixed model analysis adjusted for time, surgery type, age, sex and baseline weight for findings of absolute weight loss (P = .0110), percentage of total weight loss (P = .0089) and percentage of excess weight loss (P = .0365) between individuals with type 2 diabetes vs. those without type 2 diabetes.
“We see that having diabetes has an impact on weight loss, but we still don’t know the mechanism,” Luo told Healio after the presentation. “Previous studies show bariatric surgery will have some impact on gut hormones, which is important to diabetes control. Maybe bariatric surgery, especially [when stratified by] different types, have different impacts on the gut hormone, which leads to the results we found.” – by Regina Schaffer
Reference:
Luo Y, et al. MON-590. The Endocrine Society Annual Meeting; 2020 (conference canceled/virtual meeting).
Disclosures: Luo and Oral report no relevant financial disclosures.
Perspective
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These findings are interesting, but still very controversial. Some believe that people with diabetes have a harder time with weight loss due to a slower metabolism and because insulin or certain oral agents can promote weight gain. However, in our own analysis (Yip K, et al. Obes Surg. 2012; doi:10.1007/s11695-012-0719-8), when we matched people undergoing bariatric surgery by age and by preoperative BMI, we found diabetes was not a factor that led to less weight loss.
Frankly, people with diabetes have a terrific response to bariatric surgery. In fact, metabolic surgery is practically designed for people with diabetes. We need to make that the message: For people who are severely insulin resistant and morbidly obese, bariatric surgery is probably the gold standard, in terms of its effectiveness. There are also other issues to consider when evaluating weight loss, such as psychological comorbidities, substance abuse, depression, osteoarthritis, and other conditions that can have an impact on weight loss that we still do not fully understand. People with diabetes, if they are having bariatric surgery, often have a lot of these other things.
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