It’s estimated that as many as 44% of all people with diabetes fall into the “obese” weight category. Given that obesity and diabetes are linked, it’s no surprise many diabetes patients turn to surgery on the stomach or intestines to reduce caloric intake ─ what’s known as bariatric surgery. Bariatric surgery has been shown to be effective in achieving dramatic weight loss and even causing remission of diabetes.
Gastric bypass vs. gastric banding
But there are two major types of bariatric surgery, and a diabetes patient has to choose between them. These are gastric bypass and gastric banding, or, more specifically, Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding. In RYGB the upper section of the stomach is separated from the lower section. The upper section is then connected to the small intestine, bypassing the rest of the stomach. The smaller functioning stomach can’t hold as much food, and the person feels full after eating a smaller amount. In gastric banding, also called “lap band,” a soft, thin ring is implanted around the top section of the stomach. This creates a two-part stomach, and the person eats only enough food to fill the top part. Gastric banding is the less invasive type of bariatric surgery and requires a shorter hospital stay and recovery time.
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Which is to be preferred for obese diabetes patients who need to lose weight? A new study published in the Journal of Clinical Endocrinology & Metabolism has thrown some valuable light on the question. The researchers, led by Jonathan Q. Purnell, MD, of Oregon Health & Science University in Portland, compared the diabetes remission rates of the two procedures. (Diabetes remission is defined as an HbA1c under 5.7% or a blood glucose reading below 100; partial remission is an HbA1c between 5.7% and 6.5% and a glucose reading between 100 and 125.) The same research team had previously published an analysis of the effectiveness of the two methods that indicated a patient’s chances of achieving diabetes remission were twice as high with RYGB as it was with banding. In that study the subjects were followed up for three years, but in this new one the subjects were followed up for seven years.
The researchers studied 827 adult diabetes patients from 10 centers in the United States who had undergone bariatric surgery between 2006 and 2009. Forty-three percent of the patients were taking just one non-insulin diabetes medication, while 32% were taking two or more. About one-third (36%) were using insulin. Approximately three out of four patients (645) underwent bypass surgery, while the rest (182) had gastric banding.
Study reveals rates of diabetes remission
The results were revealing. The researchers determined that more than half (57%) of the RYGB patients achieved diabetes remission, while less than a quarter (22.5%) of the bypass patients did. This was true at all the checkpoints during the seven-year follow-up period, although the effect was most dramatic during the first two to three years. The researchers also found that certain patients were more likely to achieve remission — those who were younger, those who had had diabetes for the shortest time, and those who had used less insulin over the course of their treatment.
According to Dr. Purnell, one of their most valuable findings has to do with when the surgery was performed. As he put it, “Consistent with similar studies, we found that a patient’s chances for achieving remission in their diabetes is greatest when they undergo surgery soon after diagnosis is established and when they need fewer medications.” That is, newly diagnosed diabetes patients who are exceptionally overweight might not want to wait too long before choosing bariatric surgery — “in contrast to current practice, which is often to wait until medical treatment has failed and/or they need multiple medications or insulin to maintain control.”
Want to learn more about type 2 diabetes remission? Read “Type 2 Diabetes Remission Possible With Doable Weight Loss,” “Low-Carb Diets Lead to Greater Remission of Type 2 Diabetes” and “Reversing Type 2 Diabetes Through Weight Loss.”