Bariatric surgery associated with discontinuation of antidiabetes treatment
medwireNews: Obese patients who undergo bariatric surgery are significantly less likely to require treatment for diabetes 6 years post-surgery compared with those who do not undergo such procedures, study findings indicate.
Anne Fagot-Campagna (Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, Paris, France) and fellow researchers used the French national health insurance database to compare patterns of antidiabetes treatment in 15,650 obese patients who underwent bariatric surgery in 2009 and the same number of matched control patients who were hospitalized for obesity but did not undergo surgery.
In all, 48.5% of patients in the surgery group underwent adjustable gastric banding, while 27.7% had a gastric bypass procedure, 22.0% had sleeve gastrectomy, and the remainder underwent other procedures, such as biliopancreatic diversion.
Among patients receiving antidiabetes treatment at baseline (10.4% of the study population), 49.9% of those who underwent bariatric surgery had discontinued their treatment 6 years after surgery, compared with 9.0% of participants in the control group, a significant difference.
“Even when antidiabetes treatment was not discontinued in our study, it was often simplified,” say the researchers. Indeed, 40.0% of patients in the bariatric surgery group who were using insulin at baseline had switched to another treatment at 6 years, while 57.0% of patients taking dual therapy at baseline were receiving monotherapy or no treatment at the follow-up.
In a multivariable analysis, all types of bariatric surgery were significantly associated with a reduction in antidiabetes treatment, but the strongest association was seen for patients who underwent gastric bypass, with an odds ratio (OR) of 16.7, followed by sleeve gastrectomy and adjustable gastric banding, with corresponding ORs of 7.3 and 4.3.
The team also found that bariatric surgery was associated with a significantly lower rate of treatment initiation among patients who were not receiving antidiabetes treatment at baseline, with rates of 1.4% for the surgery group versus 12.0% in the control group. Gastric bypass was the type of surgery most strongly associated with a reduction in treatment initiation (OR=0.06).
Together, these findings indicate a “significant improvement in the frequency and complexity of antidiabetes treatment 6 years after bariatric surgery, with a marked association for patients undergoing [gastric bypass],” write the study authors in JAMA Surgery.
However, the author of an accompanying commentary, Michel Gagner (Florida International University, Miami, USA), describes the results as “a drop in the ocean” given that only 800 patients experienced resolution of their diabetes in the study, whereas almost 3 million people are currently affected by the disease in France.
Fagot-Campagna and colleagues concede that their study had a number of limitations, including lack of data on weight loss, glycated hemoglobin levels, and duration of type 2 diabetes at baseline.
“Therefore, we used treatment as a marker of type 2 diabetes,” they explain.
Furthermore, the authors emphasize that even though their findings demonstrated improvements in type 2 diabetes following bariatric surgery, approximately half of the patients who were receiving antidiabetes therapy at baseline remained on treatment at the end of the study.
“Our study highlights the message that these patients require careful lifelong follow-up to monitor obesity complications,” they conclude.
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