Diabetes remission rates after sleeve gastrectomy highest among those with less severe disease

In the study, the impact of sleeve gastrectomy on diabetes was significant in the first year, a trend that continued over five years, but to varying affect depending on disease severity. Patients on the cusp of developing diabetes, but taking no medication for it, and patients with diabetes taking oral medications, had significantly higher remission rates after surgery than patients with more severe diabetes and taking insulin injections. The cumulative five year remission rate of diabetes was 81 percent in the group without treatment and 59 percent of the group taking oral medications, while only 10 percent of those with more advanced diabetes experienced remission.

"Patients with more advanced diabetes experienced the lowest rates of remission, despite having lost just about as much weight as those with lesser disease," said Samantha Beaulieu-Truchon, MD, MSc, one of the study researchers from Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) in Canada. "The longer one has diabetes, the more resistant it appears to be to remission. This may be an important consideration for doctors and patients who hope to achieve remission after sleeve gastrectomy."

After one year, patients with pre-diabetes, but taking no medication, and those with diabetes taking oral medications, saw their blood sugar or hemoglobin A1c (HbA1c) level drop to within normal range (6.4% to 5.5% and 6.9% to 5.9%, respectively). Those taking insulin injections saw their levels decline in the first year and trended toward remission (7.9% to 6.9%). Before surgery, patients in all groups had a body mass index (BMI) of between 48 and 50. Five years after surgery, BMIs were about 25 percent less. There were 173 patients in the study.

According to the American Diabetes Association, HbA1c levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher, indicate diabetes. The higher the hemoglobin A1c, the higher the risks of developing complications related to diabetes.

"Patients with severe obesity and type 2 diabetes should be encouraged to undergo bariatric surgery sooner rather than later to obtain the best potential outcome. This study and others all suggest the chances for remission become much worse in patients with advanced diabetes," said Ninh T. Nguyen, MD, ASMBS President and vice-chair of the UC Irvine Department of Surgery and chief of gastrointestinal surgery, who was not involved in the study.

It was only last year that sleeve gastrectomy, where surgeons remove about 80 percent of the stomach, emerged as the most popular method of weight-loss surgery in America, surpassing laparoscopic gastric bypass, which had been the most common procedure for decades. Last year, sleeve gastrectomy accounted for 42.1 percent of the 179,000 procedures, followed by gastric bypass (34.2%), gastric band (14%) and Biliopancreatic Diversion with Duodenal Switch (1%).

Substantial comparative and long-term data have now been published demonstrating durable weight loss, improved medical co-morbidities, long-term patient satisfaction, and improved quality of life after sleeve gastrectomy, leading the ASMBS to recognize the procedure as an acceptable first line bariatric surgery option in an updated position statement in 2012.