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Long-term effects

Benefits from surgery evident after nine years

Study also identified the factors that result in a higher rate of long-term diabetes remission

Overweight patients with type 2 diabetes continue to experience the benefits of bariatric surgery up to nine years after the procedure, according to research published in the Annals of Surgery. According to the researchers, the study shows that obese patients with type 2 diabetes continue to improve or reverse their diabetes, as well as reduce their cardiovascular risk factors, nine years after the procedure.

"Uncontrolled diabetes can lead to serious complications such as heart and kidney disease. Only about half of diabetics in the United States currently have acceptable control of their blood glucose level," said lead investigator Dr Stacy Brethauer of the Cleveland Clinic Bariatric & Metabolic Institute. "Our study, however, shows that 80 percent of the diabetic patients still control their blood glucose five years after their bariatric surgery. Additionally, nearly one-third of gastric bypass patients had normal blood glucose levels off medication for over five years after surgery. This study confirms that the procedure can offer durable remission of diabetes in some patients and should be considered as an earlier treatment option for patients with uncontrolled diabetes."

The study also identified the factors that result in a higher rate of long-term diabetes remission. Long-term weight loss, a shorter duration of diabetes prior to surgery (less than five years), and undergoing gastric bypass surgery compared to adjustable gastric banding are the biggest predictors of sustained diabetes remission.

The retrospective study analyzed data on 217 patients with type 2 diabetes who underwent bariatric surgery between 2004 and 2007 and had at least five years follow-up. The patients were divided into three groups: 162 patients underwent gastric bypass surgery, 32 had the gastric banding procedure done, and 23 underwent sleeve gastrectomy.

Researchers used strict criteria to define glycaemic control, including an HbA1c level of less than 6 percent, which is a more aggressive target than the American Diabetes Association (ADA) guidelines. Of a  HbA1c target of 7 percent.

At a median follow-up of six years, data show that diabetes remission occurred in 50 percent of patients after bariatric surgery. Specifically, 24 percent of patients sustained complete remission of their diabetes with a blood sugar level of less than six percent without diabetes medications, and another 26 percent achieved partial remission; 34 percent of all patients improved their long-term diabetes control compared to presurgery status. As expected, the patients who received gastric bypass experienced the highest rates of weight loss and diabetic remission.

The study shows significant reductions in the number of diabetic medications used in the long-term follow-up. There was a 50 percent reduction in the number of patients requiring insulin therapy in the long term and a 10-fold increase in the number of patients requiring no medications.

In addition, the data show patients significantly reduced their cardiovascular risk factors according to the Framingham Risk Score. Diabetic nephropathy, characterized by high protein levels in the urine, improved or stabilised as well.

Shorter duration of T2DM (p<0.001) and higher long-term EWL (p=0.006) predicted long-term remission. Recurrence of T2DM after initial remission occurred in 19% and was associated with longer duration of T2DM (p=0.03), less EWL (p=0.02), and weight regain (p=0.015).

Long-term control rates of low high-density lipoprotein, high low-density lipoprotein, high triglyceridemia, and hypertension were 73%, 72%, 80%, and 62%, respectively. Diabetic nephropathy regressed (53%) or stabilised (47%).

“Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients,” the authors conclude. “Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.”

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