Gastric bypass results in ‘near-complete’ long-term diabetes prevention
medwireNews: Research shows that patients who undergo Roux-en-Y gastric bypass are extremely unlikely to develop diabetes over the following decade, and a large proportion of those who have the condition at the time of surgery achieve remission.
The findings also suggest that earlier intervention – before patients become too dependent on medications for glycemic control – increases the chances of achieving diabetes remission.
In the observational study, published in The New England Journal of Medicine, the researchers found that just 3% of 303 patients who underwent Roux-en-Y gastric bypass developed diabetes during the subsequent 12 years, compared with 26% of 164 obese patients who had not undergone surgery (mostly because of health insurance issues) and 26% of 184 obese patients identified in the community.
Among the 88 surgery patients who had diabetes at baseline, remission rates were 75% at 2 years, 62% at 6 years, and 51% at 12 years. Among those who achieved 2-year remission, 69% remained in remission at 12 years.
The researchers note that diabetes remission rates reported in other studies with long-term follow-up, such as the Swedish Obese Subjects (SOS) study, are lower than achieved in their patients.
“These longer-term differences in remission between the two studies may be attributable to the exclusive use of the Roux-en-Y gastric bypass procedure in our study as compared with the primary use of vertical banded gastroplasty and the limited use of Roux-en-Y gastric bypass in the SOS study,” they suggest.
The likelihood of diabetes remission at 12 years was strongly linked to patients’ diabetes medications at the time of surgery; remission occurred in 73% of those who were not taking antidiabetic medications at the time of surgery, falling to 56% of those who were taking oral antidiabetics and 16% of those taking insulin.
“Thus, it is intuitive to suggest that the more advanced the type 2 diabetes, the less the glycemic benefit from Roux-en-Y gastric bypass,” write Ted Adams (Intermountain Live Well Center Salt Lake, Utah, USA) and study co-authors.
They suggest that the markedly higher remission rates in patients not taking insulin is due “to the ability of partially viable beta cells to improve their function.”
Patients who underwent surgery also had, on average, significant reductions in BMI and levels of glucose, low-density lipoprotein cholesterol, and triglycerides, along with a significant increase in high-density lipoprotein levels. They also achieved stable blood pressure and glycated hemoglobin, whereas these markers generally worsened in the nonsurgical groups.
As with diabetes, the incidence rates of hypertension and dyslipidemia were much lower, and the remission rates higher, in the surgery group relative to the nonsurgical patients.
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