Bariatric surgery was originally developed as a treatment for obesity, and strict criteria (BMI of 40 or higher or more than 100 pounds to lose) were used to qualify patients for the procedure. The American Association for Bariatric and Metabolic Surgery later determined that having a lower weight (BMI 35) plus the presence of type 2 diabetes (or high blood pressure, severe sleep apnea, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, heart disease, certain gastro-intestinal disorders) were also criteria for bariatric surgery. This was because experts in the field noted that bariatric surgery seemed to reverse diabetes, even if there was limited weight loss after surgery. Long-term data on patients who experienced this diabetes reversal has not been available until recently, when one of the largest studies to examine long-term outcomes of bariatric surgery was presented at Obesity Week 2017.
In fact, almost every patient with type 2 diabetes sees improvement or even complete remission after bariatric surgery.
Two hundred and fifty-two patients treated at the Cleveland Clinic were included in the analysis. They met the following criteria:
They were diagnosed with type 2 diabetes
They were taking insulin at the time of surgery
They were followed for at least five years after the procedure
Among the group of patients, 194 had roux-en-y gastric bypass (RYGB), and 58 had sleeve gastrectomy. Endpoint goals at the seven-year mark that were evaluated included:
Reaching a glycemic target of 7 percent HbA1c without use of insulin (ADA)
Diabetes remission defined as an HbA1c less than 6.5 percent fasting blood sugar of 126 mg/dL, and being off all medications for diabetes management
The analysis confirmed “expected” short-term (first and second year post bariatric surgery) results found in earlier studies — that 51 percent of the group achieved “off insulin” status. At the seven-year mark, a full 44 percent had still maintained that goal. Separately, 70 percent of the group achieved the American Diabetes Association goal within the first two years post-surgery. At the seven-year analysis, 59 percent maintained that goal. At the short-term mark, 36 percent of the 252 individuals were still using insulin, and that statistic moved slightly higher, to 40 percent, at the seven-year evaluation mark.
The RYGB surgery was favored over the sleeve gastrectomy when it came to achieving the goals. In fact, 47 percent of the RYGB group versus 33 percent of the sleeve gastrectomy patients achieved the ADA goal at the end of the study. The RYGB group also achieved more weight loss, in the short term and longterm.
Ali Aminian, M.D., a surgeon at Cleveland Clinic who was a lead author of the study, suggests that the analysis clearly identifies that bariatric surgery achieves sustained metabolic benefits and results in prolonged positive impact on type 2 diabetes. He credits this study as being the first to show long-term efficacy of bariatric surgery in the patient who presents with excess weight or obesity, and diabetes.
When you look to the community struggling with weight issues, losing weight “the natural way” — with diet and exercise — is often discussed as the “best, natural, or optimal” way to manage obesity. In recent years, though, obesity and weight management experts herald bariatric surgery as a necessary option for individuals struggling with significant body mass, especially for those who cyclically lose and gain significant weight. Bariatric surgery is more common now and is covered by most insurance companies.
Knowing that bariatric surgery can also impact type 2 diabetes in such a positive way should be a game-changer in the management of T2D. Many patients do not want to be burdened with taking lifelong medication or undergoing daily testing (which involves some discomfort), and may fear injecting insulin. Based on this new analysis, more doctors should be exploring bariatric surgery as a viable option to treat patients who meet the criteria – a BMI of 35 or higher, who have developed type 2 diabetes.
Of course there are other considerations when exploring bariatric surgery. Patients should be evaluated to see if they are good candidates for compliance. The evaluation typically evaluates:
If the patient has no contraindications to surgery
If the patient has realistic post-surgery expectations
If the patient has access to post-surgery medical, family, and social support
If the patient’s existing medical conditions can be managed to reduce risk of post-operative complications
If the patient has access to a comprehensive center of excellence in bariatric surgery
There are of course other considerations, including age, psychological profile, and insurance coverage. Most important, the patient will have to manage dramatic changes in the amount of food that they consume during meals, and cope well with the many potential risks during and after surgery. Still, the overall benefits of being able to reverse diabetes can be an incredible option for patients who may otherwise have a lifelong chronic disease that, over time, even when managed, can impair eyesight, circulation, and have other serious negative health outcomes.
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Childhood Obesity is Setting Your Kid Up for Type 2 Diabetes
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