Bariatric surgery for type 2 diabetes: predictors of success

This study examined the characteristics which could predict which patients with type 2 diabetes would most likely respond to bariatric surgery. The authors concluded that lower blood glucose levels prior to surgery and a shorter duration of diabetes could predict response to bariatric surgery. A combination of gastric plus diversion surgical methods also predicted diabetes remission following surgery.

Patients with type 2 diabetes (T2D) who are also overweight or obese may be treated with medication or may undergo bariatric surgery. Bariatric surgery involves reducing the size of the stomach in order to reduce food intake and therefore promote weight loss. Bariatric surgery may be carried out by placing a gastric band around the stomach or removing an area of the stomach (sleeve gastrectomy). Both methods are gastric only (GO). Alternatively, the small intestine may be connected to another region of the stomach (gastric bypass or diversion). A gastric method and diversion method (GD) may be considered as an alternative to GO.

T2D patients may enter remission (no signs or symptoms of disease) after bariatric surgery. As not all patients enter remission, it is necessary to identify those who will. In addition, it is necessary to predict which patients will have better control of blood glucose (sugar) levels after surgery.

This study aimed to determine which characteristics could predict remission and improvement in blood glucose levels after bariatric surgery.

This study involved 727 T2D patients. Participants were divided into two groups. 415 participants underwent bariatric surgery. 312 participants were treated with medication only. Participants were followed over two years.

Patients treated with surgery had a higher remission rate (64%) compared to patients treated with medication (15%). In patients who underwent surgery, GD patients had a higher remission rate (76%) compared to GO patients (60%).

Patients who had lower blood glucose levels before surgery were more likely to see disease remission following surgery. Patients who had a shorter duration of diabetes were also more likely to see disease remission.

Patients who had a higher HbA1c (average blood glucose levels over 3 months) prior to surgery had a greater improvement in blood glucose levels after surgery. Patients with a larger waist circumference prior to surgery also had a greater improvement in blood glucose levels after surgery.

This study concluded that lower blood glucose levels, a shorter duration of diabetes and GD surgery can predict disease remission to bariatric surgery. HbA1c and waist circumference can predict improvements in blood glucose levels following bariatric surgery.

As this study was carried out over 2 years, it is not known whether the short-term effects of GO and GD differ.

Consult your physician to determine whether bariatric surgery is a suitable option for you.