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Gastric bypass associated with long-term diabetes control

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – More than half of patients whose type 2 diabetes resolves after gastric bypass will remain free from the disease up to 16 years later, according to study findings presented last week at the 26th Annual Meeting of the American Society for Metabolic and Bariatric Surgery in Dallas.

In the study of 177 patients with diabetes who underwent Roux-en-Y gastric bypass between 1993 and 2003, the severity of diabetes at baseline was a key predictor of whether diabetes resolved in the long term. Moreover, long-term diabetes resolution correlated with maintenance of weight loss.

“The most significant finding is that long-term resolution of diabetes seems to be linked to how severe the diabetes was at the time of surgery,” senior author Dr. James W. Maher, from Virginia Commonwealth University, Richmond, told Reuters Health. “Patients with diet-controlled diabetes had a 75% likelihood of being diabetes-free at long-term followup, while the figure was 65% diabetes-free in patients who were originally controlled with oral medications and only 28% of insulin-dependent diabetics had long-term resolution.”

The 177 subjects were followed from 5 to 16 years and diabetes status was assessed with patient interview and a tally of diabetic medications.

Eighty-nine percent of patients had complete resolution of their diabetes, which correlated with a drop in average BMI from 50.2 to 31.3. Although diabetes did not resolve in the remaining patients, they nonetheless experienced significant weight loss.

Diabetes recurrence occurred in 43% of patients and was associated with regained weight. Men were more likely than women to resolve their diabetes initially (90.3% vs. 82.1%) and be free from the disease on long-term follow-up.

“Gastric bypass is the most effective therapy for diabetes,” Dr. Maher emphasized. “It seems most likely to provide long-term relief when it is applied in obese patients early in the course of their disease. Primary care physicians need to consider this finding when they are faced with patients who are newly diagnosed with diabetes mellitus. These patients should strongly consider whether gastric bypass surgery is the best method for dealing with their disease.”