Comparative effectiveness of bariatric surgery vs. nonsurgical treatment of type 2 diabetes among severely obese adults

Abstract

Although all weight-loss approaches may improve insulin sensitivity in type 2 diabetes, bariatric surgery is believed to be the only reliable means of achieving diabetes remission. We conducted a retrospective cohort study to compare rates of diabetes remission, relapse and all-cause mortality among severely obese individuals with diabetes who underwent bariatric surgery versus nonsurgically treated individuals. Severely obese adults with uncontrolled or medication-controlled diabetes who underwent bariatric surgery or received usual medical care from 2005 to 2008 in three health care delivery systems in the United States were eligible. Diabetes status was identified using pharmacy, laboratory, and diagnosis information from electronic medical records. A propensity approach and exclusion criteria identified 1395 adults with diabetes who had bariatric surgery and 62322 who did not. Most procedures were Roux-en-Y gastric bypass (72.0% laparoscopic; 8.2% open); 4.4% were gastric banding, 2.4 % sleeve gastrectomy, and 13.2% were other procedures. At two years, bariatric subjects experienced significantly higher diabetes remission rates [73.7% (95% CI: 70.6, 76.5)] compared to nonsurgical subjects [6.9% (95%CI: 6.9, 7.1)]. Age, site, duration of diabetes, hemoglobin A1c level, and intensity of diabetes medication treatment were significantly associated with remission. Bariatric subjects also experienced lower relapse rates than nonsurgical subjects (adjusted HR: 0.19; 95% CI: 0.15 to 0.23) with no higher risk of death (adjusted HR: 0.54; 95% CI: 0.22 to 1.30). We conclude that bariatric surgery can effectively induce remission of diabetes among most severely obese adults, and this treatment approach appears to be superior to nonsurgical treatment in inducing diabetes remission.

Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery

“…The magnitude of this effect varies by procedure (1). Our own work has suggested that there is a 5-year type 2 diabetes remission rate of 68% for Roux-en-Y gastric bypass (RYGB) (6,7). Despite the mounting evidence of the impact of bariatric surgery for patients with type 2 diabetes, studies have now begun to show that type 2 diabetes remission after bariatric surgery is often not durable, with rates of relapse as high as 43% after 15 years postsurgery (6,8,9).…”

A Look Ahead at the Future of Diabetes Prevention and Treatment

“…In a recent analysis of severely obese patients with diabetes, the adjusted probability of initial remission was 12-to 24-fold greater for the 1395 patients who had bariatric surgery than for the 62 322 who received usual medical care alone. 12 In a recently reported 6-year prospective study, remission of type 2 diabetes was significantly more common among patients who underwent Roux-en-Y gastric bypass (62%) than among severely obese patients with diabetes who initially sought but did not undergo bariatric surgery (6%) and those who never sought bariatric surgery (8%). 13 In another long-term analysis, remission of type 2 diabetes occurred in 68% of 4434 patients who had Rouxen-Y gastric bypass surgery, with a median duration of remission of 8 years.…”

Treatment of type 2 diabetes, lifestyle, GLP1 agonists and DPP4 inhibitors

“…At 2 years the surgery subjects had significantly higher diabetes remission rates 73.7% compared to non surgical subjects with 6.9%. The surgical subjects also experienced lower relapse rates with no higher risk of death [28] . …”

“…An editorial in the same edition by Zimmet et al [27] suggests that the bariatric surgery should not be seen as a last resort. More recently Arterburn et al [28] did a retrospective analysis to compare rates of diabetes remission, relapse and all cause mortality amongst severely obese adults with diabetes who underwent bariatric surgery vs non-surgical treated individuals. At 2 years the surgery subjects had significantly higher diabetes remission rates 73.7% compared to non surgical subjects with 6.9%.…”