The authors explained that after gastric bypass surgery, diabetes symptoms may disappear for some patients - in many cases before they lose a lot of weight. Does this mean, therefore, that gastric bypass surgery is a "cure" for diabetes? Not necessarily, they wrote, after gathering and analyzing data from the largest community-based study that looked at the long-term outcomes after bariatric surgery among diabetes patients.
For two thirds of the participants in the study, their diabetes initially disappeared after gastric surgery - however, symptoms returned within five years among one third of them. They added the proportion of patients whose diabetes never went away after surgery, and found that 56% had no long-lasting diabetes remission.
When diabetes did go away, it stayed away for several years - an important benefit.
Experts know that bariatric surgery (weight loss surgery) is much more effective in reducing heart disease and stroke risk than medications, researchers from the Cleveland Clinic recently explained. They reported their findings in the journal Heart (October 2012 issue). Their study involved very obese patients, including those with and without diabetes.
Who receives the most benefit from gastric surgery?Lead researcher, David E. Arterburn, MD, MPH, explained that those with less severe diabetes symptoms tended to benefit the most from gastric surgery - they were the ones most likely to experience remission after the operation, and for longer.
Dr. Arterburn said:
"Gastric surgery isn't for everyone. But this evidence suggests that, once you have diabetes and are severely obese, you should strongly consider it, even though it doesn't seem to be a cure for most patients."
The study, which was carried out at multiple sites, followed 4,434 patients at Kaiser Permanente Northern California, Kaiser Permanente Southern California, and HealthPartners for a total of 14 years (1995-2008). All of the patients had type 2 diabetes, which was either uncontrolled or controlled with medication. They were also obese enough to be considered possible candidates for gastric bypass surgery.
Dr. Arterburn said "Diabetes is an increasingly common disease that tends to keep getting worse relentlessly."
Over 25 million adults in the USA have diabetes - this figure is expected to jump to 50 million by 2050. Approximately 5% of all healthcare spending in the country goes towards treating people with diabetes. Diabetes increases the risk of strokes, heart attacks, kidney disease, blindness and death.
Dr. Arterburn said that prevention is the best medicine for diabetes, by far. Once the disease sets in, it is extremely hard to get rid of.
Lifestyle change attempts do not appear to alter long-term health risks of diabetesMost intensive lifestyle change attempts at achieving remission have been disappointing for several reasons.
In a recent NIH (National Institutes of Health) study, called "Look AHEAD", which involved intensive lifestyle changes for diabetes patients, the whole thing had to be halted. Even though patients had improved diabetes type 2 risk factors, such as a loss of body weight, improved fitness, better blood pressure readings, blood sugar and lipid levels, the risks of strokes, heart attacks and death were not reduced.
Dr. Arterburn said:
"No wonder so many were excited to learn that diabetes can remit after gastric surgery - even, in some cases, before any significant weight loss - and many were hoping that gastric surgery might be a 'cure' for diabetes. Our study is the first major evidence that diabetes often recurs after gastric bypass surgery."
He added that a long period of remission after surgery has several positive effects, including a much lower risk of diabetes complications, less kidney and eye damage, and fewer strokes, heart attacks and deaths.
Dr. Arterburn and team are currently funded by the NIH to confirm whether those with initial long-term remission after surgery have better long-term outcomes, even though symptoms eventually come back.
Why does the diabetes come back after gastric bypass surgery?The researchers are not sure why the diabetes eventually relapses. It could be due to gradual weight gain, or some underlying progression of the disease. They found that there was not a close link between patients' weight before and after surgery and diabetes remission or relapse.
Researchers from the University of Massachusetts Medical Center found that 67% of diabetes patients who underwent gastric bypass surgery achieved "complete remission".
Written by Joseph Nordqvist