Although the mainstay treatments of type 2 diabetes include pharmacologic therapy and lifestyle modifications, having adequate glycemic control is difficult to achieve in most obese type 2 diabetic patients, with about 52% of American diabetics actually achieving an A1C goal of 7.0%. Previous studies have shown that procedures like bariatric surgery have produced type 2 diabetes remission in morbidly obese patients. Other studies have also verified the benefits of surgical procedures on type 2 diabetics. However, a majority of the published literature that supports bariatric surgery and diabetes remission have only short and medium term follow-up. Currently there are very few long term follow-up studies, showing remission rates greater than 5 years. The purpose of this study was to study the long-term remission rates following bariatric surgery.
A retrospective review was conducted for all patients that have undergone bariatric surgery between January 2004 and December 2007 at the Cleveland Clinic Bariatric and Metabolic Institute. These patients had type 2 diabetes prior to the operation, and have had at least 5 years of follow-up. In all, 217 patients with a follow-up anywhere from 5-9 years were included in the review. Overall, fewer patients were taking long term medications as well, while the number of patients that were on no diabetic medication increased. Patients who have had type 2 diabetes for less than 5 years achieved a 76% long-term partial/complete remission rate, while those who had it for more than 5 years achieved a 21% partial/complete remission rate. Among the bariatric surgery patients that have achieved long term complete remission, 27% of those patients have maintained remission for over 5 years.
In conclusion, bariatric surgery can greatly induce a sustainable remission and/or improvement of type diabetes among severely obese patients. Total cure can be achieved in a percentage of type 2 diabetics, with chances of long term remission high when surgery is performed within 5 years of diagnosis.
This study sheds light on how type 2 diabetes remission can be achieved through means other than pharmacologic therapy and lifestyle modifications. Remission does depend on the type of surgery performed, as well as the severity and duration of type 2 diabetes with the patient. Given the radical, invasive, and potentially complicated nature of the procedure, it should be considered in seriously obese patients when obesity management cannot be adequately or realistically achieved without surgical intervention.
- Roux-en-Y gastric bypass, gastric banding, and sleeve gastrectomy are types of bariatric surgeries used to treat type 2 diabetes.
- Bariatric surgery has been shown to not only lower weight but lower other metabolic values relating to diabetes (FBG, A1C, blood pressure, lipids, etc.) as well as cardiovascular events.
- Bariatric surgery can potentially lower the number of diabetic medications a patient is on, including insulin therapy.