Consider Sleeve Gastrectomy in Early Diabetes

Surgically treating type 2 diabetes with sleeve gastrectomy earlier in the course of disease may lead to significantly better outcomes, according to new research presented at Obesity Week 2014.

Canadian investigators looked at the impact of sleeve gastrectomy on diabetes and found this surgical approach had a varying affect depending on disease severity.

Patients on the cusp of developing diabetes, but taking no medications, and patients with type 2 diabetes taking oral medications, had significantly higher remission rates after surgery than patients with more severe diabetes and taking insulin injections.

The researchers found that the cumulative 5-year remission rate of diabetes was 81% in the group without treatment and 59% in the group taking oral medications. However, only 10% of patients with more advanced diabetes experienced remission. 

“I was surprised by the findings, particularly by the low rates of diabetes remission for patients who were treated with insulin preoperatively. In comparison, the remission rate was 81% for patients with abnormal glycemic values without treatment and 59% for patients who were taking hypoglycemic agents preoperatively,” said study investigator Samantha Beaulieu-Truchon, MD, MSc, of Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ) in Canada. 

She said the patients with more advanced diabetes experienced the lowest rates of remission even though they lost just about as much weight as those with less advanced disease. Dr. Beaulieu-Truchon said these new study findings can benefit endocrinologists because they provide specific numbers that they can discuss with their obese patients with diabetes.

“Diabetes and obesity are increasing problems in our society. It has been shown that 80% to 90% of cases of diabetes were associated with overweight and that only 50% of patients with moderate to severe disease managed to maintain glycemic control with current medications available,” Dr. Beaulieu-Truchon told Endocrinology Advisor.

“Bariatric surgery provides a more cost-effective solution compared to medical therapy, but the effectiveness is variable depending on the type of surgery. Since sleeve gastrectomy is a less invasive technique and is available to more patients, I wanted to establish intermediate-term rates of remission according to the stage of diabetes.”

In this study, all the patients underwent sleeve gastrectomy between 2006 and 2011. After 1 year, patients with prediabetes taking no medication and those with diabetes taking oral medications saw their HbA1c levels drop to within normal range (6.4% to 5.5% for patients with prediabetes and 6.9% to 5.9% for patients with diabetes on oral medications). Those taking insulin injections saw their levels decline in the first year and trended toward remission (7.9% to 6.9%).

Before surgery, patients in all groups had a BMI between 48 and 50. Five years after surgery, BMIs were about 25% less among the 173 patients in the study. 

“Sleeve gastrectomy is an interesting intermediate-term treatment for diabetic patients with severe obesity and provided superior results than medical therapy. However, earlier access to bariatric surgery before the progression of diabetes may offer better intermediate-term remission rate,” said Dr. Beaulieu-Truchon.

Sleeve gastrectomy, which involves removing about 80% of the stomach, has recently emerged as the most popular method of weight-loss surgery in America. It has surpassed laparoscopic gastric bypass, which had been the most common procedure for decades.

Reference

1. Beaulieu-Truchon S et al. Abstract A704: Diabetes Evolution After Sleeve Gastrectomy: Intermediate-term Outcomes. Presented at: Obesity Week 2014; Nov. 2-7, 2014; Boston.