Diabetes Strikes Back

December 5, 2012

For years, bariatric (weight-loss) surgery has been touted as a possible way to reverse Type 2 diabetes[1]. For just as long, however, it has been a controversial practice[2] — 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[3] 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[4] medical or lifestyle intervention.

But just how lasting is that remission? The answer has been unclear, until recently. Now, a study has been released[5] 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[6] 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!

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