Physicians often wait to recommend bariatric surgery for patients with type 2 diabetes mellitus (T2DM) who are not severely obese, recommending the weight-loss surgery only if medical therapy does not adequately control their hyperglycemia.
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Postponing such surgery, however, can negatively affect the positive metabolic changes that come with it. Because of that, Cleveland Clinic researchers recently decided to evaluate the outcome of bariatric surgery in patients with new-onset T2DM and whose weight is categorized as either obesity class I or II.
“The purpose of this study was to show the importance of doing surgery in patients who are not severely obese and do it early in the course of the disease,” says bariatric surgeon Ali Aminian, MD, who presented the data at ObesityWeek 2017, the national conference of the American Society of Metabolic and Bariatric Surgeons.
Strict inclusion criteria
Dr. Aminian analyzed the outcomes of patients with obesity class I and II and new-onset —diagnosed within 12 months before surgery — T2DM, who underwent bariatric surgery at Cleveland Clinic between 2004 and 2013 and had a least three years of follow up. Diabetes remission was defined as glycated hemoglobin (HbA1c) < 6.5 percent, and fasting blood glucose (FSG) < 126 mg/dL, and no diabetes medications.
“We had very strict inclusion criteria,” says Dr. Aminian. “We only looked at patients with class I and II obesity and who had new onset type 2 diabetes for less than a year.”
In total, 35 patients met the study criteria with a mean age of 40 years, a mean baseline body mass index of 38 kg/m2, and a median duration of T2DM of seven months (range, 1-12). Twenty-seven patients had Roux-en-Y gastric bypass, six had sleeve gastrectomy and two had gastric banding.
Overall, 89 percent of the patients achieved diabetes remission. In addition only two were still taking diabetes medication and only one had an HbA1c level > 7 percent at the last follow-up time.
Refer patients early
”It’s a remarkable finding,” says Dr. Aminian, “because it shows that if you intervene early in the course of diabetes even in patients without severe obesity, surgery can be very helpful.”
He adds: “The current guidelines say that surgery should be considered in patients with mild or moderate obesity when the medical therapies fail, however, this study shows patients need to be referred early for metabolic surgery if you want to see this kind of significant and sustainable diabetes remission.”
Visit us at ObesityWeek 2017 at Booth #843. Follow Dr. Aminian on Twitter at @Ali_Aminian_MD.