Bariatric Surgery Associated With Remission of Prediabetes and Type 2 Diabetes

An observational, prospective study found that bariatric surgery was superior to conventional treatment for achieving remission of prediabetes and type 2 diabetes (T2D), as well as reducing cardiometabolic risk and medication use. These findings were published in Obesity Medicine.¹

Patients who had prediabetes or T2D for 5 years or more were recruited to participate in the study. Patients who underwent bariatric surgery between 2007 and 2015 (n=102) were matched in a 1:1 ratio with a cohort of patients who received conventional treatment in the form of nonsurgical medical therapy and lifestyle intervention (n=71) and evaluated for remission of prediabetes or T2D, as well as other outcomes, at a 5-year follow-up visit. Remission was defined according to Buse et al² and included reduction in blood glucose level, glycated hemoglobin (HbA_1c), and number of hypoglycemic drugs.

The mean ages of the matched bariatric surgery (n=33) and conventional treatment (n=38) cohorts were 45.4±8.5 and 46.8±9.4 years; 87.9% and 94.8% were women, HbA_1c was 7.3%±2.0% and 6.9%±1.7%, and 97.0% and 65.8% had severe obesity III (weight >40.0 kg/m²), respectively.

At the 5-year follow-up visit, 66.7% of the bariatric surgery and 2.6% of the conventional treatment cohorts had achieved remission of diabetes.

In logistic regression analysis, bariatric surgery was associated with remission of T2D (odds ratio [OR], 0.67; 95% CI, 0.51-0.88; P =.006).

In addition, bariatric surgery was associated with significant reductions in systolic and diastolic blood pressures, triglycerides, total cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, HbA_1c, Framingham risk, excess weight, body mass index (BMI), and waist circumference (all P ≤.042) and a significant increase in high-density lipoprotein cholesterol (P =.007).

Among the group receiving conventional treatment, systolic blood pressure (P =.040), fasting blood glucose levels (P =.011), and aspartate aminotransferase levels (P =.013) were significantly decreased at the 5-year follow-up visit.

More study participants who underwent bariatric surgery stopped using antihypertensive (36.4% vs 5.3%) and hypoglycemic (52.6% vs 0.0%) agents, and fewer started using lipid-lowering drugs (12.1% vs 26.3%) compared with the conventional treatment cohort, respectively.

This study was limited by its small sample size and single-center design.

These data indicated that bariatric surgery promoted remission of prediabetes and T2D, and reduced cardiometabolic risk factors and the number of antidiabetic drugs used. Additional study is needed to evaluate whether these benefits persist past 5 years.

References

1. De Almeida RR, Aidar FJ, de Souza MFC, et al. Remission of diabetes and cardiometabolic risk in patients after 5 years of bariatric surgery: a case-control study. Obes Med. 2022;31:100407. doi:10.1016/j.obmed.2022.100407

2. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133-2135. doi:10.2337/dc09-9036