Most recent update: Thursday, November 21, 2019 - 11:01

Bariatric News - Cookies & privacy policy

You are here

Post-op T2DM treatment

Surgery reduces usage of anti-diabetes treatment after six years

The rate of diabetes in the surgery group was 1.4% at six years, compared with 12% in the matched control patients (p<0.001), with a greater association of GBP and SG than AGB

The six-year outcomes from a French study looking at the discontinuation or initiation of anti-diabetes treatment 6 years after adjustable gastric banding (AGB), gastric bypass (GBP) or sleeve gastrectomy (SG), has reported that bariatric surgery was associated with a significantly higher anti-diabetes treatment discontinuation rate, compared with baseline and with an obese control group without bariatric surgery. The discontinuation was particularly associated for patients who had GBP however, the researchers warned that because 50.1% of patients with pre-existing anti-diabetes treatment remained on treatment six years after surgery, the study demonstrates that bariatric patients require lifelong follow-up.

The paper, ‘Association Between Bariatric Surgery and Rates of Continuation, Discontinuation, or Initiation of Antidiabetes Treatment 6 Years Later’, published in JAMA Surgery, included more than 30,000 adults - 15,650 patients (1,633 who were receiving anti-diabetes treatment) had primary bariatric surgery (48.5% undergoing AGB, 27.7% undergoing GBP and 22.0% undergoing SG) and an obese control group included patients with no history of bariatric surgery during 2005 to 2015, as well as no cancer, pregnancy, chronic infectious disease, or serious acute or chronic disease, such as pulmonary embolism or heart failure, in 2008 to 2009.

Patients in the surgery group were then matched 1:1 on age (±5 years), sex, BMI and anti-diabetes treatment at baseline with control patients hospitalised for obesity in 2009 with no bariatric surgery between 2005 and 2015. Several bariatric surgery patients could be matched to the same control patient.

Outcomes

Gastric bypass was the most common procedure (p<0.001) performed in the subgroup of 1,633 bariatric surgery patients with anti-diabetes treatment at baseline and in the subgroup of 330 bariatric surgery insulin users (n=137 or 41.5%).

In the bariatric surgery group, patients receiving anti-diabetes treatment at baseline decreased compared with the control group (−49.9% vs −9.0%, p<0.001), the rate of insulin use also decreased but increased in the control group (−40.0% vs 119.8%, p<0.001).

Interestingly, 30.9% (n=2,348) of the 7,592 patients who had AGB at baseline underwent a revision procedure. The six-year antidiabetes treatment discontinuation rate was higher among patients who underwent conversion to GBP and SG, compared with the small number of patients with band replacement (p<0.001).

The rate of diabetes in the surgery group was 1.4% at six years, compared with 12% in the matched control patients (p<0.001), with a greater association of GBP and SG than AGB. The researchers noted that the findings support the notion that the benefits of bariatric surgery continue years after the procedure.

“This large-scale nationwide study based on health care reimbursement data found significant improvement in the frequency and complexity of anti-diabetes treatment six years after bariatric surgery, with a marked association for patients undergoing GBP,” the authors concluded. “In parallel, we demonstrated a low rate of anti-diabetes treatment initiation six years after bariatric surgery. However, patients and physicians should be aware that morbid obesity remains a chronic disease even after bariatric surgery because 50.1% of patients with pre-existing anti-diabetes treatment remained on treatment 6 years after surgery. Our study highlights the message that these patients require careful lifelong follow-up to monitor obesity complications.”

To access this article, please click here

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.