Two case studies presented by researchers from the Cleveland Clinic raise new questions about the link between weight and diabetes.
A letter published Tuesday in Diabetes Care highlights a phenomenon that may offer insights into the physiology of type 2 diabetes (T2D): if gastric bypass is reversed, it seems T2D can return, even if the weight does not.
Researchers from Cleveland Clinic, a leader gastric bypass surgery, wrote about 2 distinct case studies: the first involved a woman whose surgery was reversed after she had abdominal pain and poor nutrition, and the second was a woman who developed a fistula. This first patient had T2D before her original surgery, while the second developed it after surgery but before she came to Cleveland Clinic. Both women had received Roux-en-Y gastric bypass.
In each case, additional surgery had metabolic consequences: the first woman’s glycated hemoglobin (A1C) steadily increased after the reversal procedure, even though she regained only 10 to 15 pounds. The woman regained the weight over 6 months and it stayed the same over 2 years, but her glycemic control was did not: her A1C reached 8.2% after a year, and she required more medication to manage T2D.
The second woman, whose body weight was still 240 pounds, did not need diabetes medications after 6 months, even though her weight fell to only 205 pounds. The researchers wrote that this “might be related to the exclusion of the distal part of the stomach and duodenum, and perhaps was not exclusively dependent on weight loss.”
In June 2016, the American Diabetes Association added “metabolic surgery” to its algorithm to treat patients who have T2D and obesity. The Cleveland Clinic has published studies that show the procedure can reverse T2D in patients with a body mass index as low as 27 kg/m2, which would meet the CDC definition of being overweight but not obese. CDC defines obesity as having a body mass index of at least 30 kg/m2.
However, as the authors noted in their letter, surgery is not without risk and sometimes requires reversal. The letter is the first to describe the “metabolic consequences” of having the procedure reversed. “Further research is needed to better delineate the role of weight-independent mechanisms on glycemic changes after reoperative bariatric surgery,” the authors wrote.
Reference
Aminian A, Brethauer SA, Parekh N, Abu-Elmagd KM, Schauer PR. Metabolic consequences of restorative surgery after gastric bypass [published online February 7, 2017]. Diabetes Care. https://doi.org/10.2337/dc16-2561.
How Can Employers Leverage the DPP to Improve Diabetes Rates?
February 15th 2022On this episode of Managed Care Cast, Jill Hutt, vice president of member services at the Greater Philadelphia Business Coalition on Health, explains the Coalition’s efforts to reduce diabetes rates through the Diabetes Prevention Program (DPP).
Listen
Balancing Care Access and Fragmentation for Better Outcomes in Veterans With Diabetes
April 22nd 2021The authors of a study in the April 2021 issue of The American Journal of Managed Care® discuss the possible reasons behind the link between care fragmentation and hospitalizations in veterans with diabetes, as well as potential opportunities to address disjointed care in the context of the widespread telehealth uptake seen during the COVID-19 pandemic.
Listen
What We’re Reading: ACA Perception; FDA Blood Sugar Warning; AI and Physician Burnout
February 22nd 2024More than half of US adults have a favorable view of the Affordable Care Act (ACA); smartwatches and rings that claim to measure blood sugar levels without piercing the skin could be dangerous and should be avoided; many believe artificial intelligence (AI) could be the solution to physician burnout.
Read More
Advancements in Diabetes Technology: Coverage, Challenges, and Pregnancy Considerations
February 15th 2024Expert interviews highlight advancements and challenges in diabetes care technology, including automated insulin delivery systems and continuous glucose monitors, as well as improvements in insurance coverage.
Read More