Bariatric Surgery Brings Positive Long-Term Metabolic Effects in Patients with Insulin-Treated Type 2 Diabetes

Bariatric surgery delivers impressive metabolic effects. It lowers glycated hemoglobin (HbA1c) levels, can restore pancreatic β-cell function, and increases insulin sensitivity. It also lowers other cardiac risk factors such as high blood pressure and high cholesterol.

The long-term effects of the surgery on patients who have severe type 2 diabetes mellitus (T2DM), patients who are on insulin before surgery, however, have not been well characterized.

Recently, Cleveland Clinic researchers decided to investigate the long-term effects of surgery on that population by conducting a study on the clinical records of patients with insulin-treated T2DM who underwent Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and were followed for at least five years.

“The goal was to assess the effects of surgery on patients who have severe diabetes at the baseline,” says bariatric surgeon Ali Aminian, MD, who presented the data today at ObesityWeek 2017, the national conference of the American Society of Metabolic and Bariatric Surgeons.

44% achieved glycemic target without insulin use

Dr. Aminian and colleagues analyzed 252 patients who underwent surgery at Cleveland Clinic between 2004 and 2012. Patients had a mean baseline body mass index of 46 kg/m2, a mean HbA1c of 8.5 percent, and a median duration of T2DM of 11 years. Fifty-seven percent of the patients were female with a mean age of 52 years. The majority of the patients, 194, received RYGB; the remainder had SG.

Follow-up for patients, which ranged between five and 12 years, showed that 44 percent achieved long-term glycemic control (HbA1c <7%) without insulin use, and 59 percent met the American Diabetes Association glycemic target (HbA1c <7%). Fifteen percent achieved long-term diabetes remission, meaning HbA1c < 6.5 percent, fasting blood glucose <126 mg/dL and off diabetes medications at five years or more after surgery.

The patients showed an average BMI reduction of 11 kg/m2. In addition compared to those who received SG, the patients who had RYGB had a greater reduction in BMI (12 vs. 8 kg/m2) and in number of diabetes medications (1.1 vs. 0.6). Finally, a significant improvement in blood pressure and lipid profiles was observed.

Even in later stages, surgery is helpful

The results illustrate that bariatric surgery can have positive metabolic effects even for patient with severe diabetes, Dr. Aminian says, “It can induce significant improvement in diabetes status and metabolic profile of these patients. Insulin cessation would be very important for patients which can improve their quality of life and decrease their healthcare costs. These findings are important since they show several years after bariatric surgery, 44 percent of patients can have good diabetes control without insulin use.”

He adds, “It would be better to do the surgery earlier in the course of their diabetes, but this study shows that even in the later stages, surgery can still be helpful.”

Visit us at ObesityWeek 2017 at Booth #843. Follow Dr. Aminian on Twitter at @Ali_Aminian_MD.