Diabetes remission possible even without significant weight loss after gastric bypass surgery

More than half of patients with diabetes and a history of metabolic surgery (51%) experienced remission of their diabetes even if they did not achieve significant weight loss after surgery, according to a new study presented here today at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2023 Annual Scientific Meeting.

Researchers from Mayo Clinic in Rochester, University of California San Francisco in Fresno, and Stony Brook University Medical Center in New York performed a multicenter retrospective study of patients with diabetes who underwent gastric bypass between 2008-2017. Patient demographics and clinical data were collected annually for 14 years on a total of 815 patients with an average BMI of 45.1. Patients were followed for seven years on average, which researchers say is the longest study of patients with diabetes after gastric bypass.

Researchers concluded that the metabolic surgery patients were more likely to achieve full remission if there was no insulin use prior to surgery, a lesser need for diabetes medications, a shorter duration of the disease, a lower HbA1c at baseline, and higher weight loss after surgery – diabetes remission rates were proportional to weight loss after surgery.

This study shows that diabetes remission is not fully contingent on weight loss after gastric bypass surgery. The key is to maintain close monitoring and efficient management of diabetes after surgery. Metabolic surgery is not a magic pill, but it offers perhaps the only chance for many people to rid themselves of diabetes and its associated complications once and for all."

Omar Ghanem, MD, lead study author, metabolic surgeon at Mayo Clinic in Rochester, MN

"Health professionals should take these factors that play into remission into account when selecting patients for metabolic surgery and counseling them about the potential health outcomes," said Teresa LaMasters, MD, President, ASMBS, a bariatric surgeon and board-certified obesity medicine physician, who was not involved in the study. "There is no other therapy that produce such results and patients and their doctors owe it to themselves to explore the option to see if it's right for them. Gastric bypass has been known to put diabetes into remission even before significant weight is lost."

The ASMBS reports only about 1% of those who meet eligibility requirements get weight-loss surgery in any given year. In 2020, the number of bariatric procedures dropped to less than 200,000, the lowest in four years, due to cancellations or deferrals during the height of the COVID-19 pandemic.

According to the U.S. Centers for Disease Control and Prevention (CDC), obesity affects 42.4% of Americans. Studies show the disease can weaken or impair the body's immune system and cause chronic inflammation and increase the risk of many other diseases and conditions including cardiovascular disease, stroke, type 2 diabetes, certain cancers, and COVID-19.

The Centers for Disease Control and Prevention (CDC) reports that 37.3 million people have diabetes or little more than 11% of the US population. In 2018, a total of 8.25 million hospital discharges were reported with diabetes -- 1.87 million for major cardiovascular diseases, including: 440,000 for ischemic heart disease; 334,000 for stroke; 154,000 for a lower-extremity amputation; 226,000 for hyperglycemic crisis; and 60,000 for hypoglycemia. The CDC estimates the total direct and indirect estimated costs of diagnosed diabetes in the United States in 2017 was $327 billion.

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