By Lisa Rapaport
(Reuters Health) – Diabetics considering weight-loss surgery may want to opt for a procedure known as gastric bypass because it’s the technique most likely to send their disease into remission, according to new research.
Most of the 9,700 people with type 2 diabetes in the study achieved remission of the disease within five years of having one of the two most popular types of weight loss surgery – a Roux-en-Y gastric bypass or a sleeve gastrectomy. More than half achieved remission in one year.
People who had Roux-en-Y gastric bypass, however, were 25% less likely to have their diabetes relapse.
Gastric bypass also provided the biggest improvements to people with advanced disease, which is hardest to get into remission, said study coauthor Dr. Kathleen McTigue of the University of Pittsburgh. “For example, older people, those using insulin or more complex type 2 diabetes medication regimens and those with poor control of their blood sugar.”
Surgical weight loss has gained traction in recent years as extremely obese patients turn to it after failing to lose weight through diet, exercise or medication – strategies that can also manage diabetes.
Previous research has found that diabetics who get weight loss surgery, regardless of the type of procedure, are much more likely to achieve remission than they are without surgery. While some previous research has also found gastric bypass more effective than other procedures for diabetes remission, results have been mixed.
Roux-en-Y gastric bypass can reduce the size of the stomach from about three pints to roughly the size of a shot glass. Sleeve gastrectomies can reduce the stomach to the size of a banana.
With both procedures, patients lost substantial amounts of weight in the first year after surgery – about 23% to 29% of total body weight – then rebounded somewhat. At five years post-surgery, gastric bypass patients maintained an average loss of 24% of body weight while sleeve gastrectomy patients had a 17% loss.
Among people who achieved diabetes remission, one-third who had gastric bypass relapsed at five years, compared with 42% of those who had sleeve gastrectomy.
The researchers lacked information on certain health conditions that could impact diabetes outcomes after surgery.
Still, the results suggest the dramatic weight loss that follows these surgeries can help treat diabetes in people with severe obesity, said Dr. Luke Funk of the University of Wisconsin-Madison, coauthor of a commentary accompanying the study in JAMA Surgery.
“Bariatric surgery is a highly effective diabetes treatment for patients with severe obesity, and gastric bypass appears to be slightly more effective and durable than sleeves,” Funk said by email.
“There are no other durable treatments for diabetes remission other than non-surgical weight loss that involves dietary changes and physical activity,” Funk added. “These management options are rarely durable for patients with severe obesity.”
SOURCE: https://bit.ly/3cvfjeq and https://bit.ly/2TlZ8sk JAMA Surgery, online March 4, 2020.
