Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus Journal Article


Authors: Brethauer, S. A.; Aminian, A.; Romero-Talamas, H.; Batayyah, E.; Mackey, J.; Kennedy, L.; Kashyap, S. R.; Kirwan, J. P.; Rogula, T.; Kroh, M; Chand, B; Schauer, P. R.
Article Title: 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 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.
Journal Title: Annals of Surgery
Volume: 258
Issue: 4
ISSN: 1528-1140; 0003-4932
Publisher: Unknown  
Journal Place: United States
Date Published: 2013
Start Page: 628
End Page: 637
Language: eng
DOI/URL:
Notes: JID: 0372354; ppublish