Diabetes Strikes Back

For years, bariatric (weight-loss) surgery has been touted as a possible way to reverse Type 2 diabetes. For just as long, however, it has been a controversial practice — especially because its effect on blood glucose levels tends to appear before any significant weight is lost. Furthermore, evidence suggests that diabetes can be reversed in many people without surgical intervention. But the fact remains that bariatric surgery leads to remission of diabetes in as many as three quarters of patients, according to some estimates — a success rate that cannot be claimed by any other medical or lifestyle intervention.

But just how lasting is that remission? The answer has been unclear, until recently. Now, a study has been released that examines rates of diabetes remission following bariatric surgery over several years, and using data from three different surgery sites. Published last week in the journal Obesity Surgery, the study looked at 4,434 adults with Type 2 diabetes who underwent gastric bypass surgery between 1995 and 2008. According to an article on the study at MedPage Today, 68% of participants initially experienced complete remission of diabetes within five years of the surgery. Within this group, however, 8% of participants developed diabetes again within a year of achieving remission, and 22% relapsed within three years. (Relapse was defined as having an HbA1c level of 6.5% or higher, fasting glucose of 126 mg/dl or higher, or taking a diabetes medicine again.) After five years, 35% of those who had initially achieved remission saw the return of diabetes.


Perhaps most surprising, though, is that regaining a significant amount of weight was not associated with the return of Type 2 diabetes. In fact, participants who experienced remission, followed by a return of diabetes, tended also to be those who kept their weight near the lowest point following the surgery. Participants who never experienced remission of diabetes — as well as those who experienced lasting remission — tended also to experience steady weight gain throughout the study period. Just as remission of diabetes has long been known to occur independently of (and before) significant weight loss, sustained weight loss appears to have no positive effect on whether that remission can be sustained. Some factors, however, did predict the return of diabetes: older age at the time of surgery, poor blood glucose control before the surgery, having taken insulin before the surgery, and longer duration of diabetes before the surgery.

This study did not look at participants for long enough to determine whether bariatric surgery had lasting benefits even among those who saw a return of diabetes. It is possible that even a relatively brief remission of diabetes could have positive long-term effects, such as delaying the onset of diabetic complications. For the same reason, it is unknown whether participants who experienced a return of diabetes were likely to be otherwise less healthy in the long run, or whether their greater weight loss might “cancel out” some of the negative effects of diabetes.

What do you think of bariatric surgery for reversal of Type 2 diabetes — does this study make you reconsider your view of the topic? Have you had, or would you consider having, bariatric surgery? If you’ve had the surgery, how has it turned out for you? If you’ve reversed or significantly improved your diabetes through nonsurgical methods, do you believe you can sustain this improvement? Leave a comment below!

  • Pauline

    Sad news. Although I wasn’t ready to go under the knife for my type 2 it was comforting to believe in a back up plan to my current metformin plus very low carb and limited protein regimen. I guess chocolate cake remains out of reach.

  • Sue

    I was in remission for 10 years. When I got slack in taking my 2 mile a day, 5 days a week walks my weight started coming back and so did the diabetes.
    It’s hard to regain momentum. I know what I need to do, but it’s hard. The main thing is not giving up.
    The surgery saved my life. I may have regained a few pounds, but still healthier than before surgery.

  • marylittle

    it was an easy fix was the thinking and easy is not always the best

  • Dan

    I have reversed my diabetes completely by just changing my lifestyle of eating.
    This is the real problem with going under the knife, one does not change their lifestyle of eating and after a time they either start to gain weight and/or their diabetes returns, simply because they did not change their lifestyle of eating!
    In today’s society we are programed to take drugs, exercise, etc, to solve our ills rather than eliminate the cause of the problem.
    Except for type 1 diabetes, our diet and/or lack of exercise ( usually both) causes the insulin resistance in the first place.
    Most of the problem lies in the S.A.D. ( Sad American Diet). We eat processed foods with additives in them you would not consume unless you were trying to commit suicide, full of pesticides and hormones, etc,etc! Then, we wonder why we get sick.
    In countries that consume fresh foods without any of these problematic additives and such have a much lower occurrence of diabetes!
    I have been diabetic for 16 years, took insulin, pills, joined the gym ( exercised regularly), lost weight and still had incomplete control over my diabetes. A lifestyle of eating change occurred because of my wife being diagnosed with cancer. We dieted to help her in .her fight and it turned out to put my diabetes under control and weekly I can see my insulin resistance disappearing !
    My last A1C was 6.3.

  • Marilyn Wann

    I see no reason why it’s legal to perform amputations on healthy, normally functioning internal organs. I consider the popularity and prevalence of so-called weight-loss surgery proof of the crushing levels of prejudice toward fat people in our society. (It’s a total misnomer for the large percentage of people who regain. And no, it’s not their “fault.”)

    If people really believe that all fat people eat excessively (despite lack of evidence for that belief)…wouldn’t the compassionate and effective approach be therapy to help people resolve their issues with food and eating? And for the many, many fat people who have no issues with food or eating, again, how it is considered ethical to cut off healthy, internal organs? Especially a surgery that so often has devastating, life-destroying complications, including death. (Or is a fat person’s life not deemed worth living?)

    A colleague of mine in Health At Every Size® community points out that these mutilations are mostly performed on women and suggests that it’s a punishment for ostensibly taking too much pleasure in food. Good old feminist critique I love it!

    Marilyn Wann, author of FAT!SO?