Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus
- PMID: 24018646
- PMCID: PMC4110959
- DOI: 10.1097/SLA.0b013e3182a5034b
Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus
Abstract
Objective: Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors.
Background: Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown.
Methods: Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed.
Results: At a median follow-up of 6 years (range: 5-9) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% ± 1.5% to 6.5% ± 1.2% (P < 0.001) and FBG from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P < 0.001). Long-term complete and partial remission rates were 24% and 26%, respectively, whereas 34% improved (>1% decrease in A1C without remission) from baseline and 16% remained unchanged. 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 stabilized (47%).
Conclusions: Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.
Conflict of interest statement
The authors declare no conflicts of interest.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4110959/bin/nihms596613f1.gif)
![Figure 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4110959/bin/nihms596613f2.gif)
![Figure 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4110959/bin/nihms596613f3.gif)
Comment in
-
Diabetes: Bariatric surgery for T2DM--cure, or remission and relapse?Nat Rev Endocrinol. 2014 Jan;10(1):8-9. doi: 10.1038/nrendo.2013.222. Epub 2013 Oct 29. Nat Rev Endocrinol. 2014. PMID: 24165996 Free PMC article.
Similar articles
-
Obese Patients with Type 2 Diabetes: Outcomes After Laparoscopic Sleeve Gastrectomy.J Laparoendosc Adv Surg Tech A. 2019 May;29(5):655-662. doi: 10.1089/lap.2018.0652. Epub 2018 Nov 16. J Laparoendosc Adv Surg Tech A. 2019. PMID: 30452318
-
Can Sleeve Gastrectomy "Cure" Diabetes? Long-term Metabolic Effects of Sleeve Gastrectomy in Patients With Type 2 Diabetes.Ann Surg. 2016 Oct;264(4):674-81. doi: 10.1097/SLA.0000000000001857. Ann Surg. 2016. PMID: 27433906
-
Laparoscopic Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy for Type 2 Diabetes Mellitus in Nonseverely Obese Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Obes Surg. 2020 May;30(5):1660-1670. doi: 10.1007/s11695-019-04378-2. Obes Surg. 2020. PMID: 31912466
-
Long-term follow-up after bariatric surgery: a systematic review.JAMA. 2014 Sep 3;312(9):934-42. doi: 10.1001/jama.2014.10706. JAMA. 2014. PMID: 25182102 Free PMC article. Review.
-
The role of bariatric surgery to treat diabetes: current challenges and perspectives.BMC Endocr Disord. 2017 Aug 10;17(1):50. doi: 10.1186/s12902-017-0202-6. BMC Endocr Disord. 2017. PMID: 28797248 Free PMC article. Review.
Cited by
-
Reversal of type 2 diabetes mellitus through integrated Ayurveda dietary protocol - A case report.J Ayurveda Integr Med. 2024 Jul 23;15(4):100946. doi: 10.1016/j.jaim.2024.100946. Online ahead of print. J Ayurveda Integr Med. 2024. PMID: 39047599 Free PMC article.
-
Sleeve Gastrectomy: Literature Results.Maedica (Bucur). 2024 Mar;19(1):137-146. doi: 10.26574/maedica.2021.19.1.137. Maedica (Bucur). 2024. PMID: 38736914 Free PMC article.
-
Applicability of individualized metabolic surgery score for prediction of diabetes remission after endoscopic sleeve gastroplasty.Ther Adv Gastrointest Endosc. 2024 Apr 25;17:26317745241247175. doi: 10.1177/26317745241247175. eCollection 2024 Jan-Dec. Ther Adv Gastrointest Endosc. 2024. PMID: 38682042 Free PMC article.
-
Strategies to Maintain the Remission of Diabetes Following Metabolic Surgery.J Metab Bariatr Surg. 2023 Dec;12(2):26-34. doi: 10.17476/jmbs.2023.12.2.26. Epub 2023 Nov 29. J Metab Bariatr Surg. 2023. PMID: 38196781 Free PMC article. Review.
-
Analysis of Changes in Glucose and Lipid Metabolism in Patients with Clinically Severe Obesity and Type 2 Diabetes Mellitus Undergoing Laparoscopic Sleeve Gastrectomy-Prospective Observational Study.Obes Surg. 2024 Feb;34(2):467-478. doi: 10.1007/s11695-023-06991-8. Epub 2023 Dec 18. Obes Surg. 2024. PMID: 38105282 Free PMC article.
References
-
- Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–79. - PubMed
-
- Gregg EW, Cheng YJ, Cadwell BL, et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA. 2005;293:1868–1874. - PubMed
-
- Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world—a growing challenge. N Engl J Med. 2007;356:213–215. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials