Bariatric surgery tied to sustained metabolic improvement

Last Updated: 2017-11-03

By Megan Brooks

NEW YORK (Reuters Health) - Bariatric surgery leads to significant and durable improvement in the metabolic profile and glycemic status of patients with obesity and insulin-treated type 2 diabetes, according to the largest series with the longest follow-up to date.

"Although the impressive metabolic effects of bariatric surgery are known, its long-term effect in patients who are on insulin before surgery is not well characterized," the study team points out in an abstract presented November 2 at ObesityWeek 2017, hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

The researchers, from Cleveland Clinic in Ohio, reviewed the outcomes of 252 obese patients (161 women; average BMI, 46) who underwent either Roux-en-Y gastric bypass (194 patients) or sleeve gastrectomy (58 patients) between January 2004 and June 2012. Before surgery, patients had type 2 diabetes for 11 years on average and were taking insulin. Their average age was 52; mean hemoglobin (Hb)A1c was 8.5%.

Seven years after bariatric surgery, patients had reduced their BMI by 11.2 points on average, which was associated with significant reductions in HbA1c (by 1.5%), fasting blood glucose (by 52.5 mg/dL) and diabetes medication requirement (by 1 drug).

The proportion of patients meeting the American Diabetes Association glycemic target (HbA1c <7%) was 18% at baseline and 59% at last follow-up, a significant change. Long-term glycemic control without insulin was achieved in 44% of patients and long-term diabetes remission in 15%.

"This is pretty solid data and important because if we can discontinue the insulin that really benefits the patient, it can improve their quality of life and reduce costs, and also chronic insulin use can be associated with weight gain," lead author Dr. Ali Aminian noted in an interview with Reuters Health.

"In terms of long-term diabetes control, there was no difference between the sleeve and the bypass. In terms of weight loss, bypass was a more powerful tool," Dr. Aminian added. Both groups saw significant improvement in blood pressure and dyslipidemia following bariatric surgery.

The study also found that the longer a patient had diabetes before surgery, the less improvement in their diabetes they were likely to experience, a finding that supports previous studies showing that remission is more likely when a patient with diabetes has not started insulin.

"Certainly, we'd like to see patients sooner, but this study demonstrates bariatric and metabolic surgery can still have a significant impact, even after a person has had diabetes for years and years," Dr. Samer Mattar, ASMBS president-elect and a bariatric surgeon at Swedish Weight Loss Services in Seattle, who wasn't involved in the study, said in a conference statement.

The study had no commercial funding, and the authors have no relevant disclosures.

SOURCE: http://bit.ly/2xSbHi4

Obesity Week 2017.