Bariatric (weight-loss) surgery led to greater health improvements than optimal drug-based treatment of diabetes in a group of adults with diabetic kidney disease, according to a new study published in the journal eClinicalMedicine.
Bariatric surgery — and particularly a form of it called gastric bypass — has been shown to promote remission of type 2 diabetes and prediabetes, meaning that a person has normal blood glucose levels without taking glucose-lowering drugs. But the potential health benefits of bariatric surgery for people with diabetes who have excess body weight don’t end there — bariatric surgery is linked to better heart health, improved mobility, and better knee replacement outcomes. Bariatric surgery is now considered so beneficial, compared with its risks and with other treatment options, that it is now recommended for more people than ever before in the latest guidelines on the procedure.
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For the latest study, researchers looked at various health outcomes in 88 adults with diabetic kidney disease and class 1 obesity, meaning a body-mass index (BMI, a measure of body weight that takes height into account) of at least 30 but less than 35. Participants were randomly assigned either to undergo gastric bypass surgery, or to receive “best medical treatment” for diabetes, which consisted of taking drugs such as metformin, insulin, SGLT2 inhibitors, GLP-1 receptor agonists, and drugs to lower blood pressure and control blood lipid (cholesterol and triglyceride) levels. There were 44 participants in each group who completed all five years of follow-up for the study and were included in the final analysis.
Bariatric surgery linked to various health benefits
When it came to a key kidney-related outcome — remission of albuminuria, meaning that participants no longer had excess protein in their urine — there was a similar benefit in both groups, with 59.6% of the medical treatment group and 69.7% of the bariatric surgery group experiencing this outcome. For other health outcomes, though, bariatric surgery held a clear advantage — participants who underwent bariatric surgery were more than twice as likely to have an A1C level (a measure of long-term blood glucose control) below 6.5% (60.2% compared with 25.4% of participants), and tended to rate their quality of life as being better in survey responses. On scale of 0 to 100, participants who underwent bariatric surgery rated their general health better by an average of 13.5 points, their pain experience as better by 19.7 points, their social functioning as better by 6.1 points, their physical functioning as better by 11.1 points, and their mental health as better by 16.8 points.
The researchers noted that while kidney function was not significantly different between the two groups, bariatric surgery led to better outcomes related to blood glucose control, blood pressure, body weight, and quality of life. These results reinforce the position that bariatric surgery should be seriously considered by many people with type 2 diabetes and obesity.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “How to Keep Your Kidneys Healthy,” “Protecting Your Kidneys,” and “Kidney Disease: Your Seven-Step Plan for Prevention.”
