Study: Gastric Bypass Surgery Put Approximately 75% of Patients With Type 2 Diabetes Into Remission

Among adults with obesity and type 2 diabetes (T2D), gastric bypass surgery was more than twice as likely to lead to T2D remission compared with sleeve gastrectomy, according to a press release discussing the results of a review published in the Journal of the American College of Surgeons (JACS).¹ Patients who received gastric bypass surgery also had a 5-times greater likelihood of staying in remission, even if the weight returned, compared with patients who received a sleeve gastrectomy.

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“We saw that patients who had sleeve gastrectomy and weight recurrence had a much greater chance of having their diabetes return when compared to their gastric bypass counterparts, even after adjusting for all diabetes patient factors,” said lead study author Omar M. Ghanem, MD, FACS, DABS, a bariatric and metabolic surgeon at Mayo Clinic in Rochester, Minnesota, in a press release. 

Obesity is a risk factor for diabetes and cardiovascular disease, which are significant contributors to deaths in the United States. There are many current treatment options for obesity, one of which is bariatric (weight loss) surgery.

Gastric bypass surgery is a type of bariatric surgery that allows food to bypass the duodenum, a part of the small intestine,¹ which changes how the stomach and small intestine digest this food, according to an article published by University of California, Los Angeles, Health.² Sleeve gastrectomy is a type of surgery that makes the stomach physically smaller, thereby reducing the amount of food a person can consume.

Investigators conducted a retrospective, single-center study, to see whether patients who received bariatric surgery but regained the weight (some or all) continued to have T2D remission. The study included 270 patients with obesity and T2D who received bariatric surgery (224 patients received gastric bypass surgery, 46 received sleeve gastrectomy [control group]) at Mayo Clinic between 2008 and 2017.

Gastric bypass surgery was more effective than sleeve gastrectomy at helping patients achieve T2D remission (75% versus 34.8%, respectively). After 5 years, 5.5 times the number of patients in the sleeve gastrectomy arm experienced diabetes recurrence compared with the gastric bypass group, upon adjusting for patient and weight-related factors.

The results of a subgroup analysis showed that 50% of patients who lost the weight and regained it back (to varying degrees) continued to experience T2D remission. Moreover, nearly 60% of patients who regained 100% of the weight back experienced continued remission at 5 years. No one in the gastric sleeve arm who regained 100% of the weight was still in remission.

Regaining the weight was not associated with diabetes recurrence; however, higher HbA1c and a longer time since diabetes diagnosis prior to surgery were associated with diabetes recurrence. This study is limited by its design so long-term follow-up is needed.

“These findings help us understand how the bypass works and how to keep diabetes in remission,” Ghanem said in the press release. “Looking forward, we need to understand the mechanism behind this association so we can counsel patients on the best procedure for them when presenting to us with diabetes.”

REFERENCES

1. Gastric bypass improves long-term diabetes remission, even after weight recurrence. American College of Surgeons. News Release. February 13, 2024. Accessed on February 13, 2024. https://www.eurekalert.org/news-releases/1033825

2. Gastric Bypass Surgery. UCLA Health. Article. Accessed on February 13, 2024. https://www.uclahealth.org/medical-services/surgery/bariatrics/obesity-treatments/gastric-bypass-surgery#:~:text=Gastric%20bypass%20aids%20weight%20loss,of%20obesity%2Dcaused%20metabolic%20syndrome.