(Reuters Health) – Obese people who get bariatric surgery are less likely to require medication to control diabetes symptoms afterward, compared to those who don’t get operations to lose weight, a French study suggests.
Researchers examined data on 15,650 obese patients who had weight-loss surgery in France in 2009, including 1,633 people who were on medications to help control diabetes at the time. The surgery recipients were compared to an equal number of similar obese patients who were hospitalized that year but didn’t get bariatric surgery.
Six years later, half of the people who started out on diabetes medication and got bariatric surgery were no longer taking these drugs, compared to 9% in the control group that didn’t have the surgery, researchers report online February 14 in JAMA Surgery.
“We can hypothesize that sustainable weight loss can protect patients from disease directly associated with morbid obesity such as type 2 diabetes, which is a serious chronic disease that has become more prevalent all around the world,” said lead study author Dr. Jeremie Thereaux of La Cavale Blanche University Hospital and the University of Bretagne Occidentale in Brest, France.
“Bariatric surgery should be considered as an effective treatment of type 2 diabetes in patients suffering from morbid obesity,” Thereaux said by email. “However, bariatric surgery is not actually recommended in the U.S. and in Europe as a treatment of type 2 diabetes in less-obese patients, and our study cannot scientifically support this idea.”
Among people taking diabetes drugs at the start of the study, the biggest impact on diabetes remission was seen with gastric bypass. Compared to people who didn’t get weight-loss surgery, patients who had gastric bypass were more than 17 times more likely to discontinue diabetes medications by the end of the study.
With sleeve gastrectomy, people were more than seven times more likely to discontinue their diabetes drugs without surgery. Adjustable gastric banding was associated with more than four times the likelihood of discontinuing diabetes drugs.
With surgery, people who didn’t take diabetes medications at the start of the study were also less likely to start taking them during the follow-up period. By the end of the study, 1.4% of people who got bariatric surgery started taking diabetes drugs, compared with 12% of the control group.
The study wasn’t a controlled experiment designed to prove whether or how weight-loss surgery might help people control diabetes symptoms or reduce the need for diabetes medications. Researchers also lacked data on the amount of weight loss and how long people had been living with diabetes, both of which can independently influence whether patients need medications.
Even so, the results add to evidence that surgical weight loss may help manage diabetes, said Dr. Michel Gagner, author of an accompanying editorial and a professor of surgery at the Herbert Wertheim School of Medicine at Florida International University in Miami.
In some parts of the world, weight-loss surgery is commonly done to treat diabetes, Gagner said by email.
“In fact, even patients that are non-obese but have type 2 diabetes can get these operations,” Gagner added. “Having no more diabetes is a big thing, as diabetes attacks small blood vessels and leads to blindness, renal failure on dialysis or need for renal transplant, heart attacks and amputation of limbs.”
SOURCES: http://bit.ly/2oFj9u8 and http://bit.ly/2FLXvvQ
JAMA Surg 2018.
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