The first week of summer was a big week for weight loss surgery and diabetes in the news. The American Society for Metabolic and Bariatric Surgery (ASMBS) held their annual meeting in San Diego, CA, and the Endocrine Society met in Houston, TX. The hottest information from the ASMBS meeting can be found on their news page.
A topic of interest to both groups is treatment of diabetes with weight loss surgery.
One interesting paper that addresses both disciplines was presented by Yessica Ramos, MD, and her colleagues from the Mayo Clinic Arizona in Scottsdale, AZ. This group looked at the re-emergence of diabetes (type 2) following gastric bypass surgery. They studied 72 diabetic patients who underwent Roux-en-Y gastric bypass over a seven-year period with at least three years of follow-up.
Sixty-six patients (91%) were noted to have remission of their diabetes as defined by a glycated hemoglobin less than 6.5% off medications at any time after surgery. This remission percentage is supported by other recently published studies, as I described last March here on the blog.
"Our study findings suggest that the sooner obese people with diabetes have weight loss
surgery, the better," says lead author Dr. Yessica Ramos.
What is novel about the Ramos study is that researchers followed the patients beyond three years and found that diabetes re-emerged in 14 (21%) of these patients.
Re-emergence of diabetes was defined as glycated hemoglobin greater than 6.5%, fasting glucose greater than 7 mmol/L, or re-initiation of anti-diabetic medications. The major variable associated with diabetes re-emergence was duration of diabetes prior to bypass. Duration of diabetes has also been correlated with diabetes remission in other studies.
"Providers and patients need to be aware of this information, to have a better idea of the expected outcome and be able to make an informed decision about pursuing gastric bypass surgery," Dr. Ramos says in an Endocrine Society news release.
Richard Perugini, MD, surgical director of the Weight Center at UMass Memorial Medical Center in Worster, MA, and his colleagues presented a study at the ASMBS meeting also looking at diabetes remission following gastric bypass (see "New Study Identifies Patients Most Likely to Achieve Remission of Type 2 Diabetes After Bariatric Surgery").
"Our study further confirms type 2 diabetes becomes more difficult to manage
as it progresses," says lead author Dr. Richard Perugini.
Perugini and colleagues studied 139 diabetic patients and found that remission was as high as 96% in patients that were not on preoperative insulin and had adequate pancreatic function. These authors also concluded that early surgical intervention for diabetes results in better postoperative outcomes.
Both of these studies provide adequate evidence to support weight loss surgery for the treatment of diabetes. The studies are adequately powered for their statistical analysis, and they have appropriate follow-up. They also suggest that earlier intervention leads to improved success, with strong data to support this. The Ramos study is one of the first to show that diabetes re-emergence can happen, supporting the need for long-term follow-up in this population.
Our Bariatric and Metabolic Weight Loss Center here at Stony Brook provides comprehensive long-term care of our patients to identify and treat diabetes and other problems associated with obesity. We work closely across disciplines with our endocrinology program to identify good candidates at a time point when surgical intervention can have the best success.
Follow Dr. Pryor on Twitter!