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Surgery and T2DM remission

Bariatric surgery beats medical control for T2DM remission

Credit: Samuel Bendet, US Air Force
he results showed the advantage of an early operation together with better controlled glycaemia on diabetes remission independently of BMI.

Surgery is more effective than medical control for diabetes remission, with predictors including lower baseline glycaemia and shorter diabetes duration, according to a study, ‘Determinants of diabetes remission and glycaemic control after bariatric surgery’, Diabetes Care. In an analysis of three separate studies comparing four gastric bypass procedures and medical therapy in terms of type 2 diabetes remission rates, researchers from Rome, Italy, also found that more patients achieved remission after either Roux-en-Y gastric bypass or biliopancreatic diversion vs. gastric banding procedures, despite gastric diversion patients having a longer diabetes duration at baseline and worse glycaemic control. The results also showed the advantage of an early operation together with better controlled glycaemia on diabetes remission independently of BMI.

“Overall, the best predictors of improvement in glycaemic control after bariatric surgery were smaller waist circumference, better-controlled diabetes, and lower triglyceride levels at baseline,” Dr Simona Panunzi of the CNR Institute for Systems Analysis and Computer Science, BioMatLab, Rome, and colleagues wrote. “In addition, responders lost more weight and waist circumference after bariatric surgery, had a greater reduction in plasma triglycerides and became more insulin sensitive.”

The researchers analysed data from 727 adults with T2DM (415 bariatric surgery patients; 312 medical therapy patients) participating in three studies: the Swedish Obese Subjects study, examining diabetes status ten years after bariatric surgery; and two randomised controlled studies, both comparing gastric banding vs. conventional medical therapy.

Patients participating in the three studies underwent vertical banded gastroplasty (n=227), gastric banding (n=91), Roux-en-Y gastric bypass (n=77) and biliopancreatic diversion (n=20); researchers divided patients into gastric-only and gastric-with-diversion groups.

The researchers found that 64 and 15 percent of patients in the surgical and medical arms, respectively, experienced diabetes remission (p<0.001). Gastric bypass and diversion yielded 60 and 76 percent remission, respectively. Lower baseline glycaemia and shorter diabetes duration were the best predictors of diabetes remission. Diversion predicted higher likelihood of remission and greater weight loss when operation type was considered. Compared with non-responders, patients in remission (responders) lost more weight (25% vs 17%) and waist circumference (18% versus 13%) and experienced better insulin sensitivity.

"Surgery is more effective than medical treatment in achieving diabetes remission and tighter glycaemic control," the authors write. "The results show the advantage of an early operation together with better controlled glycaemia on diabetes remission independently of body mass index."

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