- Researchers say people who undergo gastric bypass surgery to lose weight are significantly less likely to develop type 2 diabetes again, even if they regain the weight.
- Insulin use, elevated A1c, and longer duration of type 2 diabetes before surgery were more closely associated with diabetes recurrence.
- Overall, 75% of people who underwent gastric bypass maintained diabetes remission, compared with 34% of the group who underwent sleeve gastrectomy.
People with obesity and type 2 diabetes who have gastric bypass surgery are more likely to have their diabetes go into remission than people who have gastric sleeve surgery, even if they regain weight.
That’s according to new information study Published in Journal of the American College of Surgeons.
Researchers at the Mayo Clinic in Minnesota investigated the relationship between weight loss surgery and diabetes remission.
They examined the medical records of 224 participants who underwent gastric bypass surgery at the Mayo Clinic between 2008 and 2017. They also examined the records of 46 people who had undergone gastric sleeve surgery.
All participants had been diagnosed with obesity and type 2 diabetes before gastric surgery.
Researchers observed participants for at least five years after surgery to see if weight gain led to diabetes recurrence.
The results of the new study included:
- Gastric bypass surgery resulted in high rates of remission of type 2 diabetes five years after surgery, even in people who regained significant weight.
- Participants who underwent gastric sleeve were 5.5 times more likely to have diabetes relapse than those who underwent gastric bypass.
- Of the patients who regained weight after gastric bypass surgery, about 60% remained in long-term diabetes remission, compared with none in the gastric sleeve group.
- Insulin use, elevated A1C (presurgery), and prolonged presurgical diabetes duration were more closely associated with diabetes recurrence than weight gain.
Gastric bypass surgery reduces the size of the stomach and reroutes the upper part of the small intestine, or duodenum.Gastric sleeve surgery reduces the size of the stomach 80% However, unlike gastric bypass, it does not reroute the upper part of the small intestine.
“[This study is] “This is clinically relevant and important when counseling severely obese diabetic patients about available surgical options and long-term health consequences.” Dr. Christine Wren Fieldingdirector of bariatric surgery at NYU Langone Health in New York, was not involved in the study.
“I recommend gastric bypass to all diabetics because they are most likely to experience remission of their diabetes,” she said. Today’s medical news. “However, most patients are afraid to undergo this surgery because of the implications of rerouting their bowels. Therefore, the next best option is sleeve gastrectomy, which provides equivalent diabetes control. “We don’t know, but multimodality treatment, especially GLP-1 agonists, may be able to achieve the same control as gastric bypass.”
Although weight regain was not directly associated with type 2 diabetes remission, the researchers said it was an important factor.
Because participants who regained weight continued to experience diabetes remission, the authors believe this supports the idea that the small intestine plays a major role in diabetes management.
“Among patients who regained weight after bariatric surgery, 75 percent of those who underwent gastric bypass remained in diabetic remission, compared with 34.8 percent of those who underwent sleeve gastrectomy.” Dr. Omar Ghanemsaid the Mayo Clinic metabolic surgeon and study author. Today’s medical news. “Even after accounting for patient- and diabetes-related factors, patients were 5.5 times more likely to have their diabetes relapse if their weight relapsed if they had a sleeve rather than a bypass.”
“Sixty percent of patients who underwent gastric bypass surgery and regained more than 100% of their weight loss (i.e., their current weight is higher than they were at the time of surgery) continued to maintain diabetes remission. ” Ghanem pointed out.
“This suggests that bariatric surgery that bypasses the duodenum (like a bypass) has strong effects on diabetes and metabolism that are independent of weight loss,” he added. “These surgeries should be considered the gold standard for type 2 diabetes treatment in obese patients.”
The researchers noted that the part of the small intestine that is bypassed during gastric bypass surgery is associated with the pancreas, which aids in digestion.
“The results are interesting but not surprising. The duodenum is associated with the pancreas, and gastric bypass reroutes the intestine.” Dr. Mir Ali, a bariatric surgeon and medical director at MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California, was not involved in the study. “What’s interesting is that even if you gain weight back, your diabetes is still in remission.”
“When counseling patients about weight loss surgery, I focus on why they want the surgery,” Ali said. Today’s medical news. “I recommend bypass surgery to anyone who wants to better manage their diabetes.”
“But it’s a reminder that weight loss surgery is a tool for developing new habits,” he added.
in meta-analysis In May 2021, lancetresearchers reported that obese patients who underwent gastric bypass had an increased life expectancy when looking at overall mortality, regardless of baseline diabetes status.
The study estimated that the overall increase in life expectancy after surgery was approximately 6 years.
In the new study, researchers noted that they were limited by the data given because they relied on previous studies.
It also lacked the ability to include information about lifestyle factors and other behaviors that may contribute to type 2 diabetes severity.
The authors noted that this was a retrospective, single-center study. Therefore, our results may not apply to other obesity programs across the country.
Despite the limitations, the scientists say the findings could provide an important basis for future research into the recurrence of type 2 diabetes after bariatric surgery.