Weight-Loss Surgery May Ease Type 2 Diabetes Long-Term

New research finds that weight-loss surgery is more helpful to obese patients with type 2 diabetes over the long term than regular care is.

“This important study demonstrates what many of us in weight-loss surgery have suspected for years: That for those who are suffering from diabetes and severe obesity, weight-loss surgery and a healthy lifestyle works better to control these diseases than medical care alone,” said Dr James McGinty, chief of the division of minimally invasive and baratric surgery at Mount Sinai St. Luke’s and Mount Sinai Roosevelt Hospitals, in New York City. He was not involved in the new research.

As obesity rates in the United States continue to rise, so do rates of obesity-linked type 2 diabetes. For years, improved diet, lifestyle changes and certain weight-loss medications were thought to be the only way to help obese diabetics slim down. However, the advent of weight-loss surgeries such as gastric bypass and the gastric banding procedure have brought new treatments to the fore.

According to the study authors, prior research has suggested that weight-loss surgery — also known as bariatric surgery — can help obese patients eliminate their diabetes symptoms in the short term. But it hasn’t been clear whether the improvements would last.

In the new study, researchers led by Dr. Lars Sjostrom of the University of Gothenburg in Sweden tracked outcomes for 343 patients with type 2 diabetes who’d had weight-loss surgery. They then compared this to outcomes for 260 other diabetic patients who hadn’t undergone the procedures.

After two years, 72 percent of those who’d undergone surgery were in remission from the disease, compared to only 16 percent of the other patients, the study found.

Those trends held over a much longer period of time as well: After 15 years, 30 percent of weight-loss surgery patients were still in remission but just 7 percent of the other patients were.

“In this very long-term follow-up observational study of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care,” the study authors concluded. “These findings require confirmation in randomized trials.”

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For his part, McGinty stressed that not all patients fared equally, and weight-loss surgery is certainly not a diabetes “cure-all.”

“For example, patients who had diabetes more than four years before treatment did not fare as well as those who had diabetes for less than 1 year,” he noted. “Additionally, many patients in both the surgical and medical arms of this study relapsed back to diabetes.”

Dr Howard Weintraub is clinical director of the NYU Center for the Prevention of Cardiovascular Disease at NYU Langone Medical Center in New York City. He called the new study “important.”

“It validates all of the other data that has been presented over the past few years on the remission and prevention of obesity-related diabetes,” he said. “However, it goes farther in that it examined a much longer time frame of approximately 18 years in each arm.”

The Swedish study, “does show that no matter what you do getting diabetes into remission is very hard in the long run,” Weintraub stressed. “But the good news was that there was a real reduction in the microvascular and macrovascular complications — This means that there was a drop in strokes, heart attacks and peripheral vascular complications, as well as a reduction in the neuropathy, retinopathy [vision complications] and kidney problems.”

The study is published June 11 in the Journal of the American Medical Association.

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