Less Severe Diabetes Has Better Remission With Surgery

Patients with type 2 diabetes mellitus (DM) who have less severe disease do better after sleeve gastrectomy than those who have more advanced disease, according to a new study.

“Sleeve gastrectomy should be considered as treatment for DM before disease progression for better intermediate-term results,” stated lead author Samantha Beaulieu-Truchon, MD, MSc, from the Institut Universitaire de Cardiologie et de Pneumologie de Québec in Canada. “The longer one has diabetes, the more resistant it appears to be to remission. This may be an important consideration for doctors and patients who hope to achieve remission after sleeve gastrectomy.”

To ensure optimal use of sleeve gastrectomy as treatment for DM in severely obese patients, Canadian researchers set out to establish intermediate-term data for improvement, remission, and recurrence of DM after surgery in patients with different degrees of disease.

They conducted a retrospective study of 173 patients with DM who had a body mass index (BMI) of 35 kg/m² or higher and underwent sleeve gastrectomy between 2006 and 2011. The glycemic values and information on treatment were assessed at annual intervals, including the last documented follow-up.

After 1 year, patients with prediabetes who were taking no medication and those with DM taking oral hypoglycemic agents saw their hemoglobin A1c (HbA1c) levels drop to within normal range (6.4% to 5.5% and 6.9% to 5.9%, respectively). Those injecting insulin saw their HbA1c levels decline in the first year and trended toward remission (7.9% to 6.9%). Five years after surgery, BMI levels were about 25% less in all 3 groups.

The cumulative 5-year remission rate of DM was 81% in the group without treatment and 59% in the group taking oral medications; only 10% of those who were injecting insulin experienced remission. “Patients with more advanced diabetes experienced the lowest rates of remission, despite having lost just about as much weight as those with lesser disease,” said Dr Beaulieu-Truchon.

“Patients with severe obesity and type 2 DM should be encouraged to undergo bariatric surgery sooner rather than later to obtain the best potential outcome,” said Ninh T. Nguyen, MD, Vice-chair of the University of California at Irvine Department of Surgery and Chief of Gastrointestinal Surgery, and president of the American Society for Metabolic and Bariatric Surgery. “This study and others all suggest the chances for remission become much worse in patients with advanced diabetes.”

Substantial comparative and long-term data have now been published demonstrating durable weight loss, improved medical comorbidities, long-term patient satisfaction, and improved quality of life after sleeve gastrectomy. In 2013, sleeve gastrectomy became the most popular method of weight-loss surgery in America, surpassing laparoscopic gastric bypass, which had been the most common procedure for decades.

Dr Beaulieu-Truchon presented the results of the study (Abstract A704) at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery in San Diego during ObesityWeek 2014.