Gastric bypass promotes long-term remission of diabetes despite weight gain

Important points

• Diabetes remission: Even after gastric bypass surgery causes patients to gain significant weight back, type 2 diabetes goes into remission at a high rate five years after surgery.

• Comparison of gastric bypass and sleeve gastrectomy: Patients who had sleeve gastrectomy and gained weight back were five times more likely to have diabetes again than patients who had gastric bypass surgery and gained weight back. Ta.

CHICAGO (February 13, 2024): Adults with obesity and type 2 diabetes are more likely to have gastric bypass surgery than sleeve gastrectomy to keep their diabetes in remission even after they regain weight. is much higher, Journal of the American College of Surgeons (JACS).

Some people who undergo weight loss surgery regain a significant amount of weight within a few years after the surgery. Specific types of bariatric surgery include gastric bypass, which bypasses part of the small intestine called the duodenum, and a more common procedure called sleeve gastrectomy, which reduces the size of the stomach and limits the amount of food you can eat. Includes minimally invasive surgery. Consumed.¹

“In patients who underwent bariatric surgery, we showed that duodenal bypass had a greater benefit for patients with diabetes. “Even after adjusting for all factors in people with diabetes, we found that their diabetes was much more likely to relapse,” said study lead author Rochester, Minn. said Omar M. Ghanem, MD, FACS, DABS, a bariatric and metabolic surgeon at the Mayo Clinic.

“We know that the duodenum, the first part of the intestine, plays a very important role in digestion and helps regulate the so-called ‘intestinal metabolic pathways.’ “Bypassing that axis contributes to a number of physiological effects and metabolic changes, one of which is the control of blood sugar and thus diabetes,” Dr. Ghanem said.

In this study, researchers investigated whether diabetes returned when patients regained weight after bariatric surgery. This review was based on data from 224 patients who underwent gastric bypass surgery and 46 control subjects who underwent sleeve gastrectomy at the Mayo Clinic between 2008 and 2017. All patients involved in the analysis were obese and diagnosed with type 2 diabetes before undergoing weight loss. Loss surgery. Each patient was followed for at least 5 years after surgery. He then compared diabetes remission rates into four weight relapse categories. The aim was to see if weight gain leads to diabetes recurrence.

Among the main findings of the study

• Overall, 75% of gastric bypass patients maintained diabetes remission compared with only 34.8% of patients in the sleeve gastrectomy group.

• After adjusting for patient- and weight-related factors, the odds of diabetes recurrence during the 5-year follow-up period were 5.5 times higher in the sleeve gastrectomy group compared with the gastric bypass group.

• In a subgroup analysis of gastric bypass patients, diabetes remission rates were stratified into four weight regain categories. More than half of patients in all four categories (patients who lost weight after surgery and regained 25%, 25% to 50%, 50% to 75%, and 75% or more of their initial weight loss due to surgery) I maintained my weight. Diabetes in remission.

• Of the patients who regained more than 100% of their weight after gastric bypass surgery, about 60% kept their diabetes in remission five years after surgery, compared with zero in the gastric sleeve group.

• Insulin use, higher preoperative A1c (a measure of average blood sugar), and longer preoperative diabetes duration were associated with diabetes recurrence, but not weight gain. did.

Obesity is the leading risk factor contributing to death in the United States Most of the mortality risk associated with obesity is due to the development of diabetes and cardiovascular disease.² The researchers said they intend to conduct more detailed studies to understand this relationship at the cellular level, which could better explain these findings.

“These findings will help us understand how bypass works and how to keep diabetes in remission. In the future, we will be able to advise patients with diabetes about the best treatment. “We need to understand the mechanisms behind this association,” he said. Ghanem said.

“The key determining factor in choosing the most appropriate surgery is whether the patient wants to eliminate the diabetes or to minimize the chance that the diabetes will return in the long term. Surgery is good, but we know that gastric bypass is better.”At the moment, we are performing the procedure on diabetic patients. ”

“Diabetic remission is more durable after gastric bypass than after sleeve gastrectomy, and the magnitude of the difference in this study is significant,” said Dr. said Anthony T. Petrick, MD, FACS. He was not involved in the study. “Although the number of patients who underwent sleeve gastrectomy in this study was small, the long-term follow-up is a strength of these results.”

A potential limitation of this study is that it is a retrospective, single-center study. Therefore, our results may not apply to other obesity programs across the country.

Co-author is Kamal Abi Mosleh, MD. Anthony Carbage, MD. Lauren X. Lu. Carl Hage, MD. and Barham K. Abu Dayyeh, MD, MPH.

This research is published as a press article on the JACS website.

Author Disclosure: Nothing to disclose.

Citation: Diabetes remission persists despite weight relapse: long-term metabolic effects of gastric bypass. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000000934

References

¹Noria SF, Shelby RD, Atkins KD, Nguyen NT, Gadde KM. Weight gain after bariatric surgery: scope, causes, prevention, and treatment of the problem. Curr Diab Rep. 2023 Mar;23(3):31-42. -DOI: 10.1007/s11892-023-01498 ²Abdelal M, Le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Anne Transle, MD. April 2017;5(7):161.DOI: 10.21037/atm.2017.03.107