In the study,* the impact of sleeve gastrectomy on diabetes was significant in the first year, a trend that continued over five years, but to varying affect depending on disease severity. Patients on the cusp of developing diabetes, but taking no medication for it, and patients with diabetes taking oral medications, had significantly higher remission rates after surgery than patients with more severe diabetes and taking insulin injections. The cumulative five year remission rate of diabetes was 81 percent in the group without treatment and 59 percent of the group taking oral medications, while only 10 percent of those with more advanced diabetes experienced remission.
“Patients with more advanced diabetes experienced the lowest rates of remission, despite having lost just about as much weight as those with lesser disease,” said Samantha Beaulieu-Truchon, MD, MSc, one of the study researchers from Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) in Canada. “The longer one has diabetes, the more resistant it appears to be to remission. This may be an important consideration for doctors and patients who hope to achieve remission after sleeve gastrectomy.”
After one year, patients with pre-diabetes, but taking no medication, and those with diabetes taking oral medications, saw their blood sugar or hemoglobin A1c (HbA1c) level drop to within normal range (6.4% to 5.5% and 6.9% to 5.9%, respectively). Those taking insulin injections saw their levels decline in the first year and trended toward remission (7.9% to 6.9%). Before surgery, patients in all groups had a body mass index (BMI) of between 48 and 50. Five years after surgery, BMIs were about 25 percent less. There were 173 patients in the study.
According to the American Diabetes Association, HbA1c levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher, indicate diabetes. The higher the hemoglobin A1c, the higher the risks of developing complications related to diabetes.
“Patients with severe obesity and type 2 diabetes should be encouraged to undergo bariatric surgery sooner rather than later to obtain the best potential outcome. This study and others all suggest the chances for remission become much worse in patients with advanced diabetes,” said Ninh T. Nguyen, MD, ASMBS President and vice-chair of the UC Irvine Department of Surgery and chief of gastrointestinal surgery, who was not involved in the study.
It was only last year that sleeve gastrectomy, where surgeons remove about 80 percent of the stomach, emerged as the most popular method of weight-loss surgery in America, surpassing laparoscopic gastric bypass, which had been the most common procedure for decades. Last year, sleeve gastrectomy accounted for 42.1 percent of the 179,000 procedures, followed by gastric bypass (34.2%), gastric band (14%) and Biliopancreatic Diversion with Duodenal Switch (1%).
Substantial comparative and long-term data have now been published demonstrating durable weight loss, improved medical co-morbidities, long-term patient satisfaction, and improved quality of life after sleeve gastrectomy, leading the ASMBS to recognize the procedure as an acceptable first line bariatric surgery option in an updated position statement in 2012.
The study, “Diabetes Evolution After Sleeve Gastrectomy: Intermediate-term Outcomes,” was presented at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2014, an event hosted by the ASMBS and The Obesity Society (TOS).
About Obesity and Metabolic and Bariatric SurgeryAccording to the Centers of Disease Control and Prevention (CDC), more than 78 million adults were obese in 2011–2012.1 The ASMBS estimates about 24 million people have severe obesity. Individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including type 2 diabetes, heart disease and cancer.2,3
Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for severe obesity and many related conditions and results in significant weight loss. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.4 The risk of death is about 0.1 percent5 and the overall likelihood of major complications is about 4 percent.6
About the ASMBS The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.
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*Does Taste Perception Change After Bariatric Surgery? -- John M. Morton, MD; Ulysses. S. Rosas, BA; Daniel Rogan, BS; Michelle Moore; Stanford University School of Medicine, Presented November 4, 2014
-----------------------------------------1Prevalence of Obesity Among Adults: United States, 2011–2012. (2013). Center for Disease Control and Prevention. Access October 2013 from http://www.cdc.gov/nchs/data/databriefs/db131.htm 2Office of the Surgeon General – U.S. Department of Health and Human Services. (2004). Overweight and obesity: health consequences. Accessed October 2013 from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.html 3Kaplan, L. M. (2003). Body weight regulation and obesity. Journal of Gastrointestinal Surgery. 7(4) pp. 443-51. Doi:10.1016/S1091-255X(03)00047-7. Accessed October 2013.4Encinosa, W. E., et al. (2009). Recent improvements in bariatric surgery outcomes. Medical Care. 47(5) pp. 531-535. Accessed October 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19318997 5Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp 6Flum, D. R., et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed October 2013 from http://content.nejm.org/cgi/content/full/361/5/445
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