Bariatric Surgery Promotes Remission of Type 2 Diabetes and Prediabetes
Bariatric (weight-loss) surgery promotes remission of both prediabetes and type 2 diabetes and is linked to a number of other substantial health benefits, according to a new study published in the journal Obesity Medicine.
Many previous studies have shown that in people who qualify for the procedure — generally people with severe obesity, or with obesity and other health risk factors — bariatric surgery offers potentially dramatic health benefits. Bariatric surgery can take several different forms, including gastric bypass, sleeve gastrectomy, and gastric banding. Gastric bypass involves rerouting the pathway of the digestive system to bypass most of the stomach and the upper part of the intestines. Sleeve gastrectomy involves reducing the stomach into a narrow sleeve, and gastric banding involves implanting a device that can restrict or “squeeze” the stomach to reduce its capacity.
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One recent analysis showed that undergoing bariatric surgery is linked to a lower risk of dying over time, both overall and from cardiovascular disease. Another study showed that for people with type 2 diabetes in particular, undergoing gastric bypass is linked to a longer life and lower medical costs compared with other treatment options. In people with type 2, bariatric surgery may reduce the risk for retinopathy, or diabetic eye disease. Bariatric surgery is also linked to reduced liver fat in people with type 2 diabetes and obesity — an important marker of liver health when it comes to the risk for nonalcoholic fatty liver disease (NAFLD). But possibly the most widely discussed potential benefit from bariatric surgery (other than weight loss) is remission of type 2 diabetes — having normal blood glucose levels without taking any glucose-lowering medications. Diabetes remission has been linked to the amount of weight lost following bariatric surgery, although some people experience diabetes remission even before they lose very much weight. And bariatric surgery — especially if it leads to lasting diabetes remission — has been linked to a lower risk for cancer.
For the latest study, researchers compared health outcomes over five years in 33 people who underwent bariatric surgery and 38 people who underwent conventional treatment for type 2 diabetes or prediabetes. All participants qualified for bariatric surgery, whether or not they actually went through with the procedure. The two groups were similar when it came to age and sex — the average age of participants in both groups combined was 46.1, and 91.6% were women. The bariatric surgery group had a somewhat higher average body-mass index (BMI, a measure of body weight that takes height into account) — 97.0% had a BMI of 40 or greater, compared with just 65.8% of the conventional treatment group. The bariatric surgery group also had a higher percentage of people who drank alcohol socially and a higher average education level. The average A1C level (a measure of long-term blood glucose control) was 7.3% in the bariatric surgery group and 6.9% in the conventional treatment group.
Bariatric surgery linked to diabetes remission
Within the bariatric surgery group, 94% underwent gastric bypass, while the rest underwent a different procedure. The researchers found that after five years, 22 members of the bariatric surgery group (66.7%) had experienced remission of their diabetes or prediabetes, and 20 (60.6%) saw their cardiometabolic risk factors — such as blood pressure and cholesterol levels — reach normal levels. In the conventional treatment group, only one participant (2.6%) experienced diabetes or prediabetes remission, and seven participants (18.4%) saw their cardiometabolic risk factors return to normal.
As noted in an article on the study at Endocrinology Advisor, bariatric surgery was also linked to major improvements in blood pressure, blood lipid (cholesterol and triglyceride) levels, fasting blood glucose, A1C, and BMI. Within the bariatric surgery group, 36.4% of participants were able to stop taking medications for blood pressure, compared with 5.3% of the conventional treatment group. And 52.6% of participants who underwent bariatric surgery were able to stop taking a glucose-lowering medication (not all participants were taking such a medication to begin with), compared with no one in the conventional treatment group.
The researchers concluded that bariatric surgery is linked to much greater rates of diabetes or prediabetes remission than conventional treatment after five years, as well as substantial improvements in other key areas of health. More research is needed, they wrote, to evaluate whether these benefits last for longer than five years.
Want to learn more about bariatric surgery and type 2 diabetes? Read “Is Bariatric Surgery for You?” and “Bariatric Surgery and Diabetes: Questions and Answers.”