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"Uncontrolled diabetes can lead to serious complications such as heart and kidney disease," said lead investigator Dr. Stacy Brethauer, a bariatric surgeon at the Cleveland Clinic Bariatric & Metabolic Institute in Ohio. "Only about half of diabetics in the United States currently have acceptable control of their blood glucose level."
"Our study, however, shows that 80 percent of the diabetic patients still control their blood glucose five years after their bariatric surgery," Brethauer added in a clinic news release. "Additionally, nearly one-third of gastric bypass patients had normal blood glucose levels off medication for over five years after surgery."
The researchers also found that the biggest predictors of sustained diabetes remission were long-term weight loss, a shorter duration of diabetes before surgery (less than 5 years), and having gastric bypass surgery rather than adjustable gastric banding.
The study, published online Sept. 19 in the journal Annals of Surgery, included 217 obese patients with type 2 diabetes who underwent weight loss surgery, also called bariatric surgery, between 2004 and 2007. They were followed for at least five years.
Three types of weight loss surgery were used: 162 patients had gastric bypass surgery, a nonreversible procedure that changes the size and shape of the stomach; 32 had gastric banding, which is less invasive and reversible; and 23 underwent sleeve gastrectomy, which involves removal of a large portion of the stomach.
At a median follow-up of six years, 50 percent of patients were in diabetes remission. Specifically, 24 percent of patients had complete remission of their diabetes with a blood sugar level of less than 6 percent without diabetes medications; another 26 percent had partial remission, while 34 percent of all patients had improved long-term diabetes control.
Also, the number of patients who required insulin therapy was reduced by half, and the number of patients requiring no medications rose 10-fold. In addition, patients significantly reduced their cardiovascular risk factors.
"This study confirms that the procedure can offer durable remission of diabetes in some patients and should be considered as an earlier treatment option for patients with uncontrolled diabetes," Brethauer said.
-- Robert Preidt
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