More than half of patients (51%) with type 2 diabetes and a history of metabolic surgery experienced remission of their diabetes even if they did not achieve significant weight loss after surgery, according to a new study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2023 Annual Scientific Meeting.
“This study shows that diabetes remission is not fully contingent on weight loss after gastric bypass surgery,” said lead study author, Dr Omar Ghanem, a metabolic surgeon at Mayo Clinic in Rochester, MN. “The key is to maintain close monitoring and efficient management of diabetes after surgery. Metabolic surgery is not a magic pill, but it offers perhaps the only chance for many people to rid themselves of diabetes and its associated complications once and for all.”
In the study, ‘Type 2 Diabetes Mellitus Remission after Roux-en-Y Gastric Bypass: A Multi-centered Experience with Long Term Follow Up’, researchers from Mayo Clinic in Rochester, University of California San Francisco in Fresno and Stony Brook University Medical Center in New York, sought to report T2DM resolution rates and identify specific parameters associated with remission following RYGB.
They performed a multi-centre retrospective study of 705 patients with diabetes who underwent gastric bypass between 2008-2017. Patient demographics and clinical data were collected annually for 14 years on a total of 815 patients with an average BMI of 45.1. Patients were followed for seven years on average, which researchers say is the longest study of patients with diabetes after gastric bypass.
T2DM remission was defined as HbA1c <6.5% and off anti-diabetes medications. Predictors were assessed using a multivariate logistic regression. Patients were divided into four groups based on their quartiles of total body weight loss percentage (%TBWL) to evaluate their T2DM remission rates. Data are summarized as mean± standard deviation.
A majority of patients were female (66.5% female, age 52.4± 11.4 years; BMI 45.9± 7.9 kg/m2) with a mean follow-up period of 6.3± 3.9 years. T2DM remission at last follow-up visit was demonstrated in 49% of patients. Predictive factors of T2DM remission included pre-operative duration of T2DM (p<0.01), baseline HbA1c (p<0.01), insulin use prior to surgery (p<0.01), number of anti-diabetic medications (p=0.02) and total body weight loss percentage (p=0.01). Remission rates were proportional to %TBWL [Q1 40.3%, Q2 48.9%, Q3 51.1%, Q4 55.3%] (p=0.08).
The researchers concluded that the metabolic surgery patients were more likely to achieve full remission if there was no insulin use prior to surgery, a lesser need for diabetes medications, a shorter duration of the disease, a lower HbA1c at baseline, and higher weight loss after surgery – diabetes remission rates were proportional to weight loss after surgery.
“Health professionals should take these factors that play into remission into account when selecting patients for metabolic surgery and counselling them about the potential health outcomes,” said Dr Teresa LaMasters, ASMBS President and a bariatric surgeon and board-certified obesity medicine physician, who was not involved in the study. “There is no other therapy that produce such results and patients and their doctors owe it to themselves to explore the option to see if it’s right for them. Gastric bypass has been known to put diabetes into remission even before significant weight is lost.”