Bariatric Surgery Better At Controlling Type 2 Diabetes For Some: Study

The findings of new research suggests that bariatric surgery for weight loss may be more effective at improving an individual’s type 2 diabetes than medications or other diabetes treatments. 

Nearly one-third of patients who underwent gastric bypass improved their hemoglobin levels (HbA1c) below 6 percent without the use of medication, according to a study published last week in the New England Journal of Medicine.

Researchers conducted a randomized, controlled trail to compare medical therapy with surgical therapy among patients with type 2 diabetes. A total of 150 patients with type 2 diabetes were included, who also had a body-mass index of 27 to 43. The average BMI was 37.

Patients were randomly assigned to receive intensive medical therapy alone, such as diet and exercise, or to receive medical therapy and Roux-en-Y gastric bypass or sleeve gastrectomy. Patients had average levels of glycated hemoglobin at nine percent. Researchers were aiming to reduce their hemoglobin below six percent.

By the 5-year followup, only five percent of patients who received medical therapy, without the use of drugs, were able to reduce their HbA1c levels below six percent.

Comparatively, 29% of gastric bypass patients and 23% of sleeve gastrectomy patients reduced their insulin levels below six percent.

Overall, patients who underwent surgical procedures for weight loss had a greater HbA1c reduction than those that received medical therapy alone.

Weight Loss Surgery Risks and Benefits

Gastric bypass offers patients significant weight loss, however complications and side effects continue to abound, including reports of death after bariatric surgery. Studies indicate the results of bariatric surgery vary widely.

Research published in 2014 indicated patients who underwent gastric bypass lost nearly twice the weight of those who had gastric banding, but had higher risks of short-term and long-term complications and hospitalizations.

Another study indicated many patients who have bariatric surgery experience reduced long-term survival rates, risks of macrovascular events, and negative mental health outcomes. Other studies conclude bariatric surgery patients face a much higher risk of bone fractures.

Gastric bypass patients in the new study saw a reduction of 23% in body weight. Sleeve gastrectomy patients had a 19% reduction and patients who received medical therapy had a 5 percent reduction in body weight.

Patients who underwent surgery also saw a greater reduction in their use of insulin to control their blood sugar. Gastric bypass patients reduced their use by 35%, sleeve gastrectomy patients by 34 percent and medical therapy patients by 13%.

“Five-year outcome data showed that, among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia,” the researchers determined.

Patients also reported an increase in quality-of-life. Gastric bypass patients reported general health score quality-of-life measures increased by 17 points and sleeve gastrectomy by 16 points. However, patients who underwent medical therapy only indicated quality-of-life scores improved by 0.3 points.

However, another study linked gastric bypass surgery to increased risk for substance abuse and alcohol addiction. Yet another study linked patients who underwent bariatric surgery to a 50 percent higher risk of attempting suicide.

Researchers indicate medical therapies, such as diet and exercise, are typically only effective for 20% of overweight patients. Nearly 95% of people who lose weight with rigorous weight loss programs will regain the weight, or more, within 2 to 5 years.