COMMENTARY

Can We Operate Out Diabetes?

Albert B. Lowenfels, MD

Disclosures

December 12, 2013

Can Diabetes Be Surgically Cured? Long-term Metabolic Effects of Bariatric Surgery in Obese Patients With Type 2 Diabetes Mellitus

Brethauer SA, Aminian A, Romero-Talamas H, et al
Ann Surg. 2013;258:628-636

Summary

The aim of this study was to assess the long-term impact of bariatric surgery on diabetes. The authors followed 217 morbidly obese patients with elevated glycated hemoglobin (A1c) levels to determine their diabetic status. At the end of the follow-up period, there was significant improvement in A1c levels, control of blood pressure, reduction of low-density lipoprotein cholesterol levels, number of diabetic drugs taken, and use of insulin. Gastric bypass achieved significantly better results than either sleeve gastrectomy or gastric banding.

Viewpoint

A publication[1] with short-term follow-up data from the same group demonstrated clear superiority of bypass surgery over conventional medical therapy alone for the management of diabetes. This report is reassuring because it extends the findings to at least 5 years of follow-up.

Recurrence of diabetes in this cohort was associated with 2 factors: lesser degree of weight loss and longer initial duration of diabetes. On the basis of this report, bariatric surgeons can now tell patients that there is good evidence that the initial benefits of surgery on diabetes are likely to persist, especially if weight control is maintained.

Abstract

processing....