Study Identifies Bariatric Surgery Patients Likely to Achieve Diabetes Remission

Some bariatric surgery patients are more likely to achieve complete remission of their type 2 diabetes than others, according to a new study presented at the 29th Annual Meeting of the American Society for Metabolic & Bariatric Surgery.

The study found 67% of gastric bypass patients achieved diabetes remission one year after surgery, but that number grew to more than 96% if patients were not already on insulin and did not have reduced pancreatic function as measured by the glucose disposition index (GDI). If GDI was 30% of normal, patients were less likely to achieve remission. GDI shows both how well the pancreas produces insulin and how effectively the body uses that insulin to regulate the metabolization of carbohydrates and fats.

The study also found a patient’s initial weight before surgery or weight loss after six weeks or one year, did not impact remission rates. Researchers defined remission as no longer requiring medication to achieve adequate control of elevated blood sugar.

“The study shows beta cell function, the cells in the pancreas that produce insulin, and insulin dependence, not initial weight or subsequent weight loss, are the greatest predictors of potential diabetes remission after gastric bypass,” said Richard A. Perugini, MD, a bariatric surgeon at University of Massachusetts (UM) Medical Center in Worcester and lead study author. “The study further confirms type 2 diabetes becomes more difficult to manage as it progresses.”

The study included 139 gastric bypass patients, ages 48 to 57 who, before surgery, had a BMI between 33 and 75, and required medication to manage their type 2 diabetes. Within two weeks of surgery, 36% of all patients no longer needed diabetic medications. That number rose to 46% at six weeks, 57% at six months, and 67% after one year. However, nearly all the patients (>96%) on diabetes medications other than insulin and with a GDI that had not fallen below 30% of normal, achieved remission. In addition, all patients' hemoglobin A1c (HbA1c), a measure of glucose levels in the blood, went from an average of 6.9% to 6.1% over the one-year time period.

Researchers noted gastric bypass helps people control diabetes through mechanisms other than weight loss, though weight loss is known to be effective in managing type 2 diabetes. In this study, patients on average lost 59% of their excess weight and 15 BMI points after one year.

Source: American Society for Metabolic & Bariatric Surgery

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