Metabolic and bariatric surgery found to prevent progression from prediabetes to type 2 diabetes in most patients

According to a new study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Session, pre-diabetic and severely obese patients who underwent metabolic and bariatric surgery were 20 times less likely to develop full-blown type 2 diabetes over a 15-year period compared to patients who did not undergo surgery.

Only 1.8% of patients were diagnosed with diabetes within 5 years after metabolic surgery (Roux-en-Y gastric bypass or sleeve gastrectomy), rising to 3.3% at 10 years and 6.7% at 15 years. The protective effect against diabetes was higher in patients who had gastric bypass. On the other hand, almost one-third (31.1%) of patients who did not have metabolic surgery developed diabetes from prediabetes within 5 years, increasing to 51.5% and 68.7% at 10 and 15 years, respectively. Patients lost an average of 29.4% of their body weight at 12 months and 27.6% at 36 months. The greater the weight loss at 3 years, the lower the risk of progression to diabetes.

“This is the first study to analyze the long-term effects of metabolic and bariatric surgery on the potential progression of prediabetes, and the effects are significant and lasting,” said study co-author David Parker, MD, a bariatric surgeon at Geisinger Medical Center in Danville, Pa. “Metabolic surgery has been demonstrated to be both a prevention and a treatment for diabetes.”

Prediabetes is a serious condition that occurs when blood sugar levels are higher than normal but not high enough to be considered type 2 diabetes. According to the CDC, approximately 98 million Americans (more than 1 in 3) have prediabetes and 38.4 million have diabetes.

This retrospective study included 1,326 patients who were prediabetic before undergoing Roux-en-Y gastric bypass (n=1,154) or sleeve gastrectomy (n=172) between 2001 and 2022. Nonsurgical controls from the primary care cohort were propensity matched by hemoglobin A1c, age, sex, and body mass index (BMI). More than 80% of patients were female, with a mean age of 45 years, mean BMI of 46.9, and a median follow-up of 7.2 years.

“Just think about the negative impact that diabetes has on your health. [that] “Patients may be able to avoid diabetes through metabolic surgery,” said Marina Kurian, M.D., Ph.D., president of ASMBS, who was not involved in the study. “Preventing diabetes is the best treatment.”

The ASMBS reports that approximately 280,000 metabolic and bariatric procedures were performed in 2022, but this represents only about 1% of people who met the eligibility requirements based on BMI. According to the Centers for Disease Control and Prevention (CDC), obesity affects 42.4% of Americans. Research has shown that obesity can weaken or impair the body’s immune system and cause chronic inflammation, which can increase the risk of many other diseases and conditions, including cardiovascular disease, stroke, type 2 diabetes, and certain cancers.

Metabolic, bariatric, or weight loss surgery, such as gastric bypass and sleeve gastrectomy, has proven to be the most effective, long-term treatment for severe obesity. The procedures reverse or reverse diseases such as type 2 diabetes, heart disease, and high blood pressure, and result in significant and permanent weight loss. Their safety profile is comparable to some of the safest and most commonly performed surgeries in the United States, such as gallbladder surgery, appendectomy, and knee replacement.

Courtesy of the American Society for Metabolic and Bariatric Surgery