New Study Finds Diabetes Under Control Without Insulin, 7 Years After Bariatric Surgery

WASHINGTON, Nov. 2, 2017 /PRNewswire/ -- Seven years after bariatric surgery, 44 percent of patients with severe obesity had their diabetes under control and were able to stop taking insulin, and 15 percent achieved diabetes remission, according to researchers from the Cleveland Clinic in Ohio who presented their findings* today at ObesityWeek™ 2017, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The annual conference is hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

Cleveland Clinic researchers reviewed the outcomes of 252 patients who had either Roux-en-Y gastric bypass (194 patients) or sleeve gastrectomy (58 patients) between January 2004 and June 2012. Prior to surgery, patients had type 2 diabetes for an average of 11 years, were taking insulin, and had an average body mass index (BMI) of nearly 46 kg/m2. The average age of the patients was 52.

"This study shows bariatric surgery can induce a significant and sustainable improvement in metabolic profile of patients with obesity and insulin-treated type 2 diabetes, typically a much more difficult group to achieve glycemic control or remission," said Ali Aminian, MD, study co-author and associate professor of surgery at the Cleveland Clinic in Ohio. "Anytime a patient can come off insulin and still have their diabetes be under control, it's a big deal, in terms of quality of life, decreased healthcare costs and preventing weight gain."

While scientists have been conducting research on bariatric and metabolic surgery for years, the Cleveland Clinic study is the largest study of insulin-treated diabetes patients with the longest follow-up.

After seven years, patients on average had reduced their BMI by 11 points, which was associated with a significant reduction in blood sugar, as measured by Hemoglobin A1C (HbA1c) and fasting blood glucose. Before surgery and when on insulin, only 18 percent of patients met the American Diabetes Association blood sugar target of HbA1c of less than 7 percent for people with diabetes. Seven years later, 59 percent met the target. The longer a patient had diabetes before surgery, the less improvement they were likely to experience. Previous studies have shown remission is more likely when a patient with diabetes had not begun insulin.

Gastric bypass patients lost more body weight and used fewer diabetes medications than sleeve gastrectomy patients. A significant improvement in blood pressure and cholesterol was observed in both surgical groups.

Gastric bypass surgery involves cutting and stapling the stomach and rearranging or rerouting the small bowel. Sleeve gastrectomy, the most popular method of bariatric surgery, is performed by removing approximately 80 percent of the stomach and leaving a narrow gastric tube or "sleeve." In both procedures, because the stomach is made smaller, patients feel satisfied with less food. 

"Certainly, we'd like to see patients sooner, but this study demonstrates bariatric and metabolic surgery can still have a significant impact, even after a person has had diabetes for years and years," said Samer Mattar, MD, president-elect, ASMBS and a bariatric surgeon at Swedish Weight Loss Services in Seattle Washington, who was not involved in the study.

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for severe obesity and many related conditions and results in significant weight loss.[1] The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.[2] The risk of death is about 0.1 percent[3] and the overall likelihood of major complications is about 4 percent.[4] According to a 2014 study from the Cleveland Clinic's Bariatric and Metabolic Institute, laparoscopic bariatric surgery has complication and mortality rates comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement.[5]

According to the National Center for Health Statistics, 39.8 percent of adults and 18.5 percent of children in the U.S. had obesity in 2015-2016, the highest rate ever for adults. Hispanic adults had an obesity rate of 47 percent and Non-Hispanic black adults a rate of 46.8 percent. Obese is medically defined as having a body mass index (BMI), a ratio of height to weight, of more than 30. The ASMBS estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40 or more.

About the ASMBS

The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.

Dr. Aminian's bio:

https://my.clevelandclinic.org/staff/18077-ali-aminian

Cleveland Clinic's Bariatric & Metabolic Institute: https://my.clevelandclinic.org/departments/bariatric

*Long-Term Effects of Bariatric Surgery in Patients with Insulin-Treated Type 2 Diabetes: 44% at Glycemic Target without Insulin Use (A110)

Ali Aminian, MD; Zubaidah Nor Hanipah, MD; Suriya Punchai, MD; Jennifer Mackey, RN MSN CBN;

Stacy Brethauer, MD, FASMBS; Philip Schauer, MD – all from Cleveland Clinic, Cleveland, OH

[1] Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370

[2] Encinosa, W. E., et al. (2009). Recent improvements in bariatric surgery outcomes. Medical Care. 47(5) pp. 531-535. Accessed October 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19318997

[3] Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp

[4] Flum, D. R., et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed October 2013 from http://content.nejm.org/cgi/content/full/361/5/445

[5] Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/

SOURCE American Society for Metabolic and Bariatric Surgery

Related Links

http://www.asmbs.org