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Type 2 diabetes remission

Surgery is no diabetes cure for most

Most diabetics never experience resolution of symptoms or relapse within five years of surgery
Remission may still have health benefits
Prevention remains best medicine for condition
Dr David Arterburn, above, says that most bariatric patients are diabetic five years after their operation.

A new study has questioned gastric bypass’ effectiveness in treating type 2 diabetes, saying that most patients either never experience resolution of their symptoms, or demonstrate a relapse of their symptoms within five years.

However, the study says, even the temporary remission of symptoms which most patients experience may have health benefits.

Tracking 4,434 gastric bypass patients with controlled or uncontrolled type 2 diabetes who had surgery between 1995 and 2008, the study found that 31.8% of the patients never experienced a remission of their symptoms, and of those that did, 35.1% experienced a relapse within five years, meaning only 44.3% of patients experienced a durable remission in their condition. 

The median length of remission was 8.3 years. The most lengthy remission periods were seen in patients who had less severe diabetes or where the intervention took place at an earlier stage in the disease’s development. 

The weight of participants before or after surgery was not correlated with either the remission or relapse of diabetes, but the post-surgical weight trajectories were significantly different for those who never remitted, those who relapsed, and those who remitted for durable periods of time

Dr David Arterburn, lead author of the study and associate investigator at Group Health Research Institute, said that the results highlighted the fact that prevention remains “by far the best medicine” for the condition. 

“Gastric surgery isn’t for everyone, but this evidence suggests that, once you have diabetes and are severely obese, you should strongly consider it, even though it doesn’t seem to be a cure for most patients.” Dr David Arterburn

However, he said, the period of remission experienced by most bariatric patients was likely to have had significant health benefits for the patients, including less damage to eyes and kidneys, and fewer heart attacks, strokes and deaths. He is currently performing research to investigate this possibility.

“Gastric surgery isn’t for everyone,” said Arterburn. “But this evidence suggests that, once you have diabetes and are severely obese, you should strongly consider it, even though it doesn’t seem to be a cure for most patients.”

Arterburn said that it was currently unclear why diabetes was re-emerging in bariatric surgery patients, but it could be due to weight regain or a progression in the severity of the underlying diabetes.

Despite the findings, bariatric surgery remains the most effective method of treating type 2 diabetes, with lifestyle interventions proving relatively impotent. The intervention arm of the Look AHEAD study, a large-scale study into the treatment of diabetes, was stopped recently after it was shown that it did not lower the cardiovascular risk of participants.

"No wonder so many were excited to learn that diabetes can remit after gastric surgery - even, in some cases, before any significant weight loss - and many were hoping that gastric surgery might be a 'cure' for diabetes," Arterburn said. "Our study is the first major evidence that diabetes often recurs after gastric bypass surgery."

Arterburn is also leading a randomised controlled pilot trial of intensive behavioral treatment vs. gastric surgery with colleagues from the University of Washington. 

Drs. Arterburn's co-authors were: Andy Bogart, MS, and Mary Kay Theis, MA, MS, of Group Health Research Institute; David McCulloch, MD, of Group Health Cooperative; Nancy E. Sherwood, PhD, and Patrick J. O'Connor, MD, MPH, of HealthPartners Institute for Education and Research; Stephen Sidney, MD, MPH, of the Kaiser Permanente Northern California Division of Research, in Oakland; Karen J. Coleman, PhD, of Kaiser Permanente Southern California, in Pasadena; Guilherme M. Campos, MD, of the University of Wisconsin, in Madison; Sebastien Haneuse, PhD, of Harvard School of Public Health, in Boston; and Joe Selby, MD, MPH, of the Patient-Centered Outcomes Research Institute (PCORI), in Washington, DC. Dr. Arterburn is also an affiliate associate professor of medicine and Dr. McCulloch is a clinical professor of medicine at the University of Washington School of Medicine.

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