Gastric bypass surgery tied to diabetes remission

(Reuters Health) – Three in four obese people with diabetes who had a common type of weight-loss operation called Roux-en-Y gastric bypass (RYGB) experienced remission of their diabetes within a year after surgery, a Danish study found.

Five years later, 27 percent of the people who achieved remission had relapsed, the study also found. However, the total proportion of people in remission held steady, suggesting that some people achieved remission later and remained free of diabetes symptoms.

“We have known for some years from smaller studies . . . that Roux-en-Y gastric bypass surgery has the ability to make type 2 diabetes go into remission, meaning freeing patients from the use of glucose-lowering drugs,” said lead study author Dr. Lene Ring Madsen of Aarhus University in Denmark.

“The novelty of our study is that we can confirm these results in large real-world cohorts of unselected patients with severe obesity and type 2 diabetes,” Madsen said by email.

Gastric bypass reduces the size of the stomach from about three pints to roughly the size of a shot glass.

In the current study, researchers examined data on 1,111 people with type 2 diabetes, the more common form that’s associated with obesity and aging. All the patients had Roux-en-y gastric bypass procedures between 2006 and 2015.

Patients were more likely to achieve diabetes remission after surgery when they were younger, had been living with diabetes for shorter periods of time, and had less severe diabetes. Men also did better than women.

Within six months of surgery, 65 percent of patients had their diabetes go into remission. This rate rose to 74 percent over the next six months and remained there for the rest of the study period.

Diabetics who were taking insulin before their weight-loss surgery had 43 percent lower remission rates than patients who didn’t need insulin, the study also found.

Compared to 1,074 similar obese patients with type 2 diabetes who didn’t have RYGB surgery, those who did were less likely to develop so-called microvascular complications like kidney or eye problems caused by diabetes. With surgery, the risk of eye damage was 48 percent lower and the chance of kidney disease was 46 percent lower.

Within 30 days of surgery, 7.5 percent of patients had repeat hospitalizations for complications related to the gastric bypass procedures.

The study, reported in Diabetologia, wasn’t a controlled experiment designed to prove whether or how weight-loss surgery might help people control diabetes symptoms or reduce the need for diabetes medications.

Even so, the results suggest that obese people with diabetes may not necessarily want to wait to have surgery if they’re considering this option, since their chance of remission goes down the longer they live with diabetes, said Dr. Sheri Colberg of Old Dominion University in Norfolk, Virginia.

“The earlier after diabetes diagnosis that gastric bypass surgery is done, the greater its potential impact on preventing many diabetes-related health complications,” Colberg, who wasn’t involved in the study, said by email.

“Given that it involves major abdominal surgery, having a gastric bypass procedure is certainly not without some major health risks, including short-term complications from the surgery itself and longer-term ones like micronutrient deficiencies due to malabsorption of vitamins and minerals in the diet,” Colberg added.

“This study does suggest that more than half of patients undergoing such surgeries were able to remain diabetes-free, which reduces their risk of the long-term health complications associated with diabetes,” Colberg said. “Patients who are unable to lose weight any other way may benefit more than those who can lose weight (and reverse diabetes or limit its impact) via adopting a healthier lifestyle — it will need to be an individual choice and is certainly not for everyone.”

SOURCE: bit.ly/2UePjdZ Diabetologia, online February 6, 2019.