Gastric Bypass Surgery Offers Long-Term Resolution of Diabetes

A new study has found that bariatric surgery is one of the most effective long-term treatments for morbidly obese patients with type 2 diabetes.

Researchers at the Virginia Commonwealth University (VCU; Richmond, USA) conducted a retrospective analysis of 177 people with morbid obesity and type 2 diabetes that underwent gastric bypass surgery between 1993 and 2003. The researchers divided patients into three categories, based on their diabetes treatment prior to surgery: insulin dependent (59); oral medications (83); or diet and lifestyle changes only (35). The patients were followed from 5 to 16 years. The researchers found that the patients who had a recurrence of diabetes regained about 10% more of their excess weight than those with no recurrence. Those most likely to experience a recurrence of diabetes regained the most weight or had a more severe insulin-dependent form of diabetes prior to surgery; on average, patients who remain free of diabetes had excess weight loss of about 73%, while diabetes returned in those that had 66% or less excess weight loss. More than 75% of patients who were controlling their diabetes with dietary and lifestyle management and more than 65% who were using oral medications before surgery continued to be diabetes-free after gastric bypass surgery. About 70% of insulin-dependent patients had a recurrence of diabetes independent of weight loss or gain, and 40% of those who regained about 20% of the weight also experienced a return of the disease. In all, nearly 90% of morbidly obese patients with type 2 diabetes experienced diabetes resolution within the first year of gastric bypass surgery, and about 60% remained diabetes-free 5 to 16 years later.

The study was presented at the 26th annual meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS), held during June 2009 in Grapevine (TX, USA).

"The severity of the diabetes at the time of surgery and the regain of excess weight loss long-term seem to be the primary determinants of long-term diabetes resolution after gastric bypass surgery,” said study presenter and coauthor Professor James Maher, M.D. "This study suggests that people with Type 2 diabetes and morbid obesity who get surgery before becoming insulin-dependent have the greatest chance for complete resolution and avoiding the progression of diabetes.”

People who are morbidly obese have a body mass index (BMI) score of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as type 2 diabetes, heart disease, or sleep apnea. The American Diabetes Association (ADA) recently recommended that bariatric surgery be considered for adults with a BMI score of over 35 and Type 2 diabetes, especially if diabetes is difficult to control under their current therapy. The most common methods of bariatric surgery are laparoscopic gastric bypass and laparoscopic adjustable gastric banding (LAGB).

Related Links:
Virginia Commonwealth University