Diabetes

20 September 2013

Long-term diabetes control with weight loss surgery

Weight loss surgery can benefit overweight patients with type 2 diabetes for up to nine years after the procedure, according to a new study.

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Weight loss surgery can benefit overweight patients with type 2 diabetes for up to nine years after the procedure, according to a new study.

Long-term follow-up showed that patients continued to have improvements in their diabetes, as well as a reduction in risk factors for cardiovascular disease, the researchers reported.

"Uncontrolled diabetes can lead to serious complications such as heart and kidney disease," said lead investigator Dr Stacy Brethauer, a bariatric surgeon at the Cleveland Clinic Bariatric & Metabolic Institute in Ohio. "Only about half of diabetics in the United States currently have acceptable control of their blood glucose level."

"Our study, however, shows that 80% of the diabetic patients are still in control of their blood glucose five years after their bariatric surgery," Brethauer added in a clinic news release. "Additionally, nearly one-third of gastric bypass patients had normal blood glucose levels off medication for over five years after surgery."

The researchers also found that the biggest predictors of sustained diabetes remission were long-term weight loss, a shorter duration of diabetes before surgery (less than 5 years), and having gastric bypass surgery rather than adjustable gastric banding.

Three types of surgery

The study, published online on 19 September in the journal Annals of Surgery, included 217 obese patients with type 2 diabetes who underwent weight loss surgery, also called bariatric surgery, between 2004 and 2007. They were followed for at least five years.

Three types of weight loss surgery were used: 162 patients had gastric bypass surgery, a non-reversible procedure that changes the size and shape of the stomach; 32 had gastric banding, which is less invasive and reversible; and 23 underwent sleeve gastrectomy, which involves removal of a large portion of the stomach.

At a median follow-up of six years, 50% of patients were in diabetes remission. Specifically, 24% of patients had complete remission of their diabetes with a blood sugar level of less than 6% without diabetes medications; another 26% had partial remission, while 34% of all patients had improved long-term diabetes control.

Also, the number of patients who required insulin therapy was reduced by half, and the number of patients requiring no medications rose 10-fold. In addition, patients significantly reduced their cardiovascular risk factors.

"This study confirms that the procedure can offer durable remission of diabetes in some patients and should be considered as an earlier treatment option for patients with uncontrolled diabetes," Brethauer said.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about weight loss surgery.

 

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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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