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Press Release: New Study Identifies Patients Most Likely to Achieve Remission of Type 2 Diabetes After Bariatric Surgery
Some bariatric surgery patients are more likely to achieve complete remission of their Type 2 diabetes than others, according to a new study* presented here at the 29th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).
The study found 67 percent of gastric bypass patients achieved diabetes remission one year after surgery, but that number grew to more than 96 percent if patients were not already on insulin and did not have reduced pancreatic function as measured by the glucose disposition index (GDI). If GDI was 30 percent of normal, patients were less likely to achieve remission. GDI shows both how well the pancreas produces insulin and how effectively the body uses that insulin to regulate the metabolization of carbohydrates and fats.
The study also found a patient’s initial weight before surgery or weight loss after six weeks or one year, did not impact remission rates. Researchers defined remission as no longer requiring medication to achieve adequate control of elevated blood sugar.
“The study shows beta cell function, the cells in the pancreas that produce insulin, and insulin dependence, not initial weight or subsequent weight loss, are the greatest predictors of potential diabetes remission after gastric bypass,” said Richard A. Perugini, MD, a bariatric surgeon at University of Massachusetts (UM) Medical Center in Worcester and lead study author. “The study further confirms Type 2 diabetes becomes more difficult to manage as it progresses.”
The study included 139 gastric bypass patients, ages 48 to 57 who, before surgery, had a body mass index (BMI) between 33 and 75, and required medication to manage their Type 2 diabetes. Within two weeks of surgery, 36 percent of all patients no longer needed diabetic medications. That number rose to 46 percent at six weeks, 57 percent at six months and 67 percent after one year. However, nearly all the patients (>96%) on diabetes medications other than insulin and with a GDI that had not fallen below 30 percent of normal, achieved remission. In addition, all patients’ hemoglobin A1c (HbA1c), a measure of glucose levels in the blood, went from an average of 6.9 percent to 6.1 percent over the one-year time period.
Researchers noted gastric bypass helps people control diabetes through mechanisms other than weight loss, though weight loss is known to be effective in managing Type 2 diabetes. In this study, patients on average lost 59 percent of their excess weight and 15 BMI points after one year.
Gastric bypass surgery, which makes the stomach smaller and allows food to bypass part of the small intestine, causes physiological changes, including alterations to the level of the gut hormones that regulate the metabolization of sugars and fats.[i],[ii] Studies have shown the surgery improves Type 2 diabetes even before significant weight loss has occurred.[iii]
The American Diabetes Association recommends people with Type 2 diabetes and a BMI of 35 or more (about 60 pounds overweight) should consider bariatric surgery. According to the Centers for Disease Control and Prevention (CDC), the number of Americans with diabetes has tripled in the past 30 years to more than 20 million. CDC reports over half of Americans with Type 2 diabetes have a BMI greater than or equal to 30 and about 80 percent of those with BMI greater than or equal to 35 have one or more metabolic diseases.[iv] Type 2 diabetes is the seventh leading cause of death in the United States.[v]
In addition to Dr. Perugini, study UM Medical Center co-authors include John J. Kelly, MD, Philip Cohen, MD, Donald R. Czerniach, MD and Karen A. Gallagher-Dorval, RN.
Re: Bariatric surgery resulted in 67% Remission of Type 2 Diabetes
Press Release: Modified Bariatric Surgery Provides Remission of Type 2 Diabetes
Type 2 diabetes often reverses after modified weight loss surgery, especially when the duration of diabetes is less than 10 years, a new study finds. The results will be presented Tuesday at The Endocrine Society’s 94th Annual Meeting in Houston.
“Modified bariatric surgery such as sleeve gastrectomy should be considered at an earlier stage of Type 2 diabetes, rather than as a last resort,” said the senior investigator, Kirtikumar Modi, MD, an endocrinologist at Medwin Hospital, Hyderabad, India.
Sleeve gastrectomy is a less radical form of restrictive weight loss surgery than gastric bypass, the most common type of bariatric surgery. It reduces the size of the stomach using laparoscopic (“keyhole”) surgery and stomach stapling. Recent research shows that the procedure can resolve or greatly improve Type 2 diabetes in obese patients and even in some diabetic patients who are not obese.
Initially, Modi and co-workers studied 43 patients with Type 2 diabetes who had sleeve gastrectomy with ileal interposition, in which the ileum, a part of the small intestine, is moved closer to the stomach. All patients had poorly controlled diabetes, with an average disease duration of 10 years. On average, their body mass index (BMI) was 33 kg/m2.
After sleeve gastrectomy, 20 (47 percent) of the patients no longer had diabetes, at an average follow-up of 20 months, the authors reported. Remission of diabetes was defined as having a hemoglobin A1c level (a measure of blood sugar control over the past three months) below 6.5 percent and no longer needing insulin or oral hypoglycemic agents (blood sugar-lowering medications). The other 23 patients in this group all needed fewer or smaller doses of oral diabetes medications, Modi said. Of the 30 patients who had high blood pressure before surgery, 27 (90 percent) no longer had hypertension after the operation, according to the study abstract.
Patients who had better improvement in diabetes remission and other metabolic abnormalities were those who had diabetes less than 10 years and a BMI above 27, the researchers found. When they excluded nonobese patients from analysis, the diabetes remission rate increased to 85 percent, similar to that reported with gastric bypass surgery, Modi said.
Based on these predictors of good outcomes, the researchers assigned 17 additional patients with Type 2 diabetes to undergo a different modification of bariatric surgery, called diverted sleeve gastrectomy. This laparoscopic procedure diverts food away from parts of the small intestine, including the duodenum, where absorption of nutrients begins. The patients received this procedure because, compared with the original group, they had a longer duration of diabetes—15 years on average—and a lower BMI (29 kg/m2), which predicted worse outcomes with sleeve gastrectomy, Modi explained.
An average of nine months after diverted sleeve gastrectomy, 12 patients, or more than 70 percent, had remission of diabetes. The investigators reported that the remaining five patients had decreased requirements for oral hypoglycemic medications. Seven of the eight patients (nearly 88 percent) who had high blood pressure before surgery no longer did postoperatively.
“Modified bariatric surgery promises to be an effective treatment for achieving a cure of Type 2 diabetes and other metabolic abnormalities like high blood pressure,” Modi said.