People with type 2 diabetes saw similar benefits in insulin sensitivity and pancreatic beta cell function when they lost a similar amount of weight, regardless of whether they did so through bariatric (weight-loss) surgery or dietary changes, according to a new study presented at the virtual Digestive Disease Week conference and reported in a Healio article.
For years, bariatric surgery — especially gastric bypass surgery, in which the stomach is made drastically smaller — has been recognized as a way to potentially achieve remission of type 2 diabetes. Remission typically means that a person shows no signs of diabetes, and no longer needs to take medications to manage blood glucose levels. Even if someone doesn’t achieve diabetes remission after bariatric surgery, it’s often possible to drastically reduce doses of insulin or other medications while achieving better blood glucose control. One of the reasons why bariatric surgery has been seen as so promising is that the metabolic benefits of the treatment — improvements in blood glucose control — tend to occur even before a person loses a significant amount of weight.
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Insulin sensitivity improved roughly equally in bariatric surgery and dietary groups
The researchers found that when participants achieved an 18% weight loss, insulin sensitivity increased by roughly the same amounts in both the bariatric surgery and dietary intervention groups — with one measure of insulin sensitivity, insulin-stimulated glucose disposal, ranging from 29.4 to 54.5 micromoles per kilogram of fat-free mass in the surgery group and from 30.5 to 61.6 micromoles per kilogram of fat-free mass in the diet group (higher numbers mean better insulin sensitivity). Pancreatic beta cell function also improved in both groups — with an increase of 1.11 units seen in the surgery group and 1.83 units seen in the diet group.
The researchers concluded that at least once significant weight loss is achieved, the metabolic benefits of bariatric surgery are comparable to those of losing weight through dietary changes. These results may help dispel the notion that bariatric surgery causes metabolic changes that aren’t directly related to, or seen proportionately with, weight loss. Outside of small study settings, though, it remains to be seen whether dietary changes can compete with bariatric surgery in actually achieving the substantial weight loss needed to achieve remission of type 2 diabetes, or to gain meaningful metabolic benefits short of diabetes remission.
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