Weight loss surgeries can help treat prediabetes and type 2 diabetes

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Surgeons say gastric surgeries are the best weight management option for people with obesity or prediabetes. PER Images/Getty Images
  • Researchers report that people with prediabetes who have weight loss surgery are 20 times less likely to develop diabetes than those who did not have surgery.
  • They added that people with type 2 diabetes who had Roux-en-Y gastric bypass surgery remained in remission for up to 15 years.
  • They note that a third type of bariatric surgery – SADI-S or SIPS – does not produce the glucose level swings that people who have other types of weight loss surgery might have.

Two studies on gastric surgeries and diabetes have been presented at the American Society for Metabolic and Bariatric Surgery’s 2024 Annual Scientific Meeting.

In one study, researchers reported that people with prediabetes and severe obesity who had gastric surgery were much less likely to develop type 2 diabetes than people with prediabetes who did not have bariatric surgery.

The other study concluded that type 2 diabetes could remain in remission after surgery for 15 years and most people who underwent the procedures sustained their weight loss for at least 20 years.

The first study, which hasn’t been published yet in a peer-reviewed journal, was a retrospective review of research.

In it, researchers looked at 1,326 participants who had prediabetes and underwent either Roux-en-Y gastric bypass or sleeve gastrectomy between 2001 and 2022.

More than 80% of the participants were female with an average age of 45 and a mean body mass index (BMI) of nearly 47. The mean follow-up period was about 7 years.

The researchers reported that the participants who had obesity and prediabetes and who underwent bariatric surgery were 20 times less likely to develop type 2 diabetes over 15 years than those who did not undergo surgery.

During follow-up, the scientists also found that:

  • Nearly 2% of participants progressed to diabetes within 5 years after surgery.
  • About 3% of participants progressed to diabetes within 10 years after surgery.
  • Less than 7% of participants progressed to diabetes within 15 years after surgery.

In comparison, 31% of those with prediabetes who did not have metabolic surgery developed type 2 diabetes within 5 years. In addition, 51% of participants with prediabetes who didn’t have the surgery developed type 2 diabetes within 10 years with 68% developing diabetes within 15 years.

The researchers also noted weight loss, indicating that those who had bariatric surgery lost an average of 29% of their body weight at 12 months and 27% at 36 months.

“Prediabetes is diabetes,” said Dr. Christine Ren-Fielding, the chief of bariatric surgery at NYU Langone Health and surgical director of NYU Langone’s Weight Management Program in New York. “Some people think in terms of ‘it’s only prediabetes.’ But you shouldn’t wait until you have diabetes. If you have prediabetes, you should take it seriously.”

“If you are working to manage your weight or blood sugar, having prediabetes means your treatment strategies aren’t working, and you should talk to your doctor about adjusting treatments,” Ren-Fielding, who wasn’t involved in the study, told Medical News Today.

In the second study, which also hasn’t been published yet in a peer-reviewed journal, researchers reported that type 2 diabetes remained in remission for up to 15 years in participants who had Roux-en-Y gastric bypass surgery, which reduces the size of the stomach and reroutes the small intestine as well as limits food intake and calorie absorption.

The participants also kept most of the weight off for up to 20 years.

“Weight loss surgery is very effective, but it is underutilized,” said Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California.

“It has long-term benefits as soon as the 15-year remission. However, only 1 to 2 percent of people who would benefit from surgery get it. For health insurance coverage, people need a [body mass index] BMI of 40, which could be 35 to 40 if there are other medical conditions,” Ali, who wasn’t involved in the study, told Medical News Today.

Researchers reviewed the remission rates and weight loss outcomes of 2,045 people who underwent Roux-en-Y gastric bypass surgery between 2001 and 2008 during a follow-up of up to 20 years.

Participants were, on average, 46 years old with a BMI of nearly 48 before surgery. A total of 677 participants had pre-operative diabetes.

The findings included:

  • Remission rates for those with pre-operative diabetes were 54% at the three-year mark.
  • Remission rates for those with pre-operative diabetes were 38% after 15 years.
  • About 10% of those with insulin-dependent diabetes had remission in the same time frame.
  • The rate of persistent diabetes was higher in people with insulin-treated diabetes before surgery.
  • A peak weight loss of nearly 32% was achieved after 18 months.
  • Weight loss stabilized at 23% after 10 years and up to 20 years.

“People on insulin at the time of surgery probably won’t experience complete remission,” Ren-Fielding said. “You are better off having surgery during the early stages of diabetes before needing insulin. If you need insulin, your pancreas is already overworked. Surgery will help, but not as much as if it was done before insulin was needed.”

Obesity affects about 42% of people in the United States, according to the Centers for Disease Control and Prevention. the condition can weaken the immune system, cause chronic inflammation, and contribute to cardiovascular disease, stroke, type 2 diabetes, and some cancers.

“The best therapy for metabolic syndrome and type 2 diabetes remains surgery,” said Dr. Mitchell Roslin, the chief of bariatric surgery at Northwell Lenox Hill Hospital in New York.

“Too few people are educated about surgery. My comment would be that medical therapy keeps you from dying, but probably [completed] surgical procedures keep you from aging as fast,” Roslin, who was not involved in the study, told Medical News Today.

“For many reasons, the best operation for diabetes is not bypass or sleeve, but SADI-S or SIPS,” Roslin added. “The difference is that bypass has high glucose fluctuations and these do not. Sleeves do not alter intestinal mechanisms, which are key for sensing what is eaten and providing satiety. SADI combines a sleeve with an intestinal bypass. As a result, get the mechanical fullness signals initiated in the stomach and the lasting fullness that comes from food hitting the bottom portion of the intestine.”

“Sleeve patients get full fast, but a year or two after surgery, they get hungry quickly,” he added. “Bypass is similar, but Sadi is more lasting and has no glucose swings.”

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