All 3 methods caused patients to lose weight, but 2 were more likely to produce remission in type 2 diabetes.
When it comes to bariatric surgery, if the goals are both weight loss and remission of type 2 diabetes (T2D), not all methods are created equal, according to results published today in JAMA Surgery.
A study of patients in the United Kingdom finds that the gastric bypass and sleeve gastrectomy methods were more likely to produce T2D remission than gastric banding. The authors, led by Jan Peter Yska, PharmD, wrote that while the risks and benefits of different methods should be evaluated, these 2 methods “may be considered as new treatment options,” for type 2 diabetes.
This retrospective cohort study involved records from 2978 patients who had surgery between 2005 and 2012. All started with a body mass index (BMI) of at least 35. Researchers identified 569 patients with type 2 diabetes and matched them against 1881 patients with diabetes who did not have bariatric surgery, to compare results of both different surgical methods and treatment with medication over time.
Most patients receiving surgery were female (66.8%) as were matched controls (65%); the mean age of the surgery patients was 50.9 years, compared with 52.2 for the control group. Control patients were slightly less obese (mean BMI 42.8) compared with the surgery group (mean BMI 45.9). Glycated hemoglobin (A1C) were similar; more patients receiving surgery were using insulin than those in the control group.
Among the patients who had surgery, 94.5 T2D remissions were seen per 1000 person years, compared with 4.9 remissions/1000 person years among the control patients. Remission was strictly defined as the patient having completely stopped all non-insulin anti-diabetic medication and recorded an A1C of less than 6.0%, a much stricter definition of remission than some studies. Surgery patients had an 18-fold increased chance of remission compared with those who did not have surgery.
The group most likely to experience remission were those who had gastric bypass surgery; in raw numbers there were 69 of 280 patients (adjusted RR, 43.1; CI 95%, 19.7-94.5); followed by sleeve gastrectomy, 19 of 83 patients (adjusted RR, 16.6; CI 95%, 4.7-58.5); and gastric banding, 18 of 200 patients (adjusted RR, 6.9; CI 95% 3.1-15.2).
The greatest decreases in A1C and blood glucose levels were observed in the first 2 years after surgery, according to the researchers. “To our knowledge, this is the first population-based study to investigate the remission rate of (type 2 diabetes) in patients who underwent bariatric surgery in comparison with matched patients with (type 2 diabetes) without surgery using data from medical records from general practitioners,” they wrote.
Results showing greater likelihood of remission for gastric bypass and sleeve gastrectomy than gastric banding were consistent with other studies that looked at various procedures without comparison to matched controls.
Patients having the surgery also lost large amounts of weight compared with the matched controls: 2 years after surgery, those without surgery saw their BMI drop an average of 2.3, while gastric bypass group dropped by 10.7, the sleeve gastrectomy dropped 8.2, and the gastric banding dropped 8.0.
Yska JP, van Roon EN, de Boer A, et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population based cohort study in the United Kingdom. JAMA Surg [published online September 30, 2015.] 2015; doi:10.1001/jamasurg.2015.2398.