Can Diabetes Be Cured by Surgery?
Introduction: This study was designed to examine the long-term remission rates and factors related to the risk for relapse among patients undergoing gastric bypass for the treatment of type 2 diabetes.
Methods: The retrospective cohort study involved 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass between 1995 and 2008.
Results: Complete remission of diabetes was found in 68.2% of patients within 5 years after surgery. The mean duration of remission was 8.3 years. Of these patients who achieved complete remission, 35.1% relapsed within 5 years of achieving remission. Risk factors for relapse included older age, poor preoperative glycemic control (A1c ≥6.5%), treatment with insulin before surgery, and longer duration of diabetes.
Conclusion: Many, but not all, severely obese patients with type 2 diabetes who undergo gastric bypass surgery experience durable remission, and about one-third relapse within 5 years of initial remission.
For more than a decade, it has been recognized that bypass surgery produces dramatic results in patients with type 2 diabetes mellitus (T2DM). Indeed, as many as 80% of T2DM patients who undergo diversionary gastric surgery leave the hospital on NO ANTIDIABETIC MEDICATION. The remarkably favorable metabolic changes that are seen essentially immediately postoperatively occur prior to sufficient weight loss to explain the phenomenon. Hence, other forces beyond simple weight loss must be functioning. It has recently been shown that diversionary gastrointestinal surgery produces a pronounced and sustained elevation of glucagon-like peptide-1, which results in blunting of glucagon, improved satiety, stimulation of glucose-dependent insulin secretion, and modulation of gastric emptying.
It would be very discouraging if gastric surgery benefits were fleeting. Fortunately, they are not. A recent series from Sweden has documented generous long-term benefits,1 and it is reassuring to find similarly sanguine results reported from the United States data.
Arterburn et al performed a retrospective cohort study of T2DM patients who had undergone gastric bypass surgery in the United States between 1995 and 2008. Essentially, two-thirds of the gastric surgery patients went into complete diabetes remission within the first 5-year, postoperative interval, but almost one-third of these patients experienced a relapse within the next 5 years. The median time to relapse after T2DM remission was 8.3 years.2
In an era dominated by oral and parenteral pharmacotherapies for T2DM, there appears to be reluctance on the part of clinicians to opt for a surgical solution. Several data sets point to the safety and long-term efficacy of bariatric surgery. Based upon the high degree and durability of success postoperatively, bariatric surgery for T2DM appears to be underutilized.
- Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367(8):695-704.
- Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23(1):93-102.