"Unsuccessful" Bariatric Surgery May Still Lead to Diabetes Resolution

Bariatric surgery has been shown to reduce the incidence of type 2 diabetes and albuminuria. However, data connecting the magnitude of weight loss and reduction in obesity-related co-morbidities is limited.

An article has been published in Diabetes Technology & Therapeutics showing a small weight loss (5 to 10%) is sufficient to greatly improve obesity-related disease.

The study, conducted by researchers at the Cleveland Clinic, followed 31 patients who had failed to lose or maintain weight loss (that is, lost less than 25% of baseline weight) for a median of 6 years post-operatively. The patients were all type 2 diabetics as defined by ADA with bariatric surgery performed at the researcher’s facility. They had a mean weight loss of 13.7%.

All study participants experienced significant improvements in fasting blood glucose, serum triglycerides, and systolic blood pressure. Mean fasting blood glucose decreased from 159 mg/dL to 128 mg/dL and the standard deviation decreased from 67 mg/dL to 35 mg/dL (showing tighter control as well). Mean serum triglycerides decreased from 152 mg/dL to 116 mg/dL.

Mean systolic blood pressure deceased from 135 mmHg to 124 mmHg. At the study’s start, 23% of participants were considered to have acceptable blood pressure control (as defined by ADA). By the end of the study, 58% of the cohort had acceptable blood pressure control.

Significant improvements in health were noted even among 31 patients with limited (7%) mean weight loss. Factors beyond strictly weight loss contribute to these results including changes in gut hormones, gut microbiota, and bile acids. The researchers also note that the cohort’s long-term, intense engagement with their medical team also contributed to improved health.

The researchers concluded that the mechanism of diabetes resolution post—bariatric surgery may not be solely dependent on weight loss. Independent neurohormonal changes may provide an alternative explanation for the resolution of diabetes in patients who have less than ideal results after bariatric surgery.