Obesity surgery is very effective against diabetes. A study reveals that five years after a bypass, 75% of patients had normal blood sugar levels.
Bariatric surgery is booming. In five years, the number of people who have benefited from this technique has simply doubled. And this is not the last study published in the Annals of surgery which will deny this success. Five years after surgery, 80% of the 217 diabetic patients included in this study had normal blood sugar levels. More precisely, 24% of patients were in complete remission, therefore cured of their diabetes (with an HBA1C lower than 6%) and 26% were in partial remission. Another contribution of bariatric surgery in these diabetics: the number of patients needing insulin was reduced by half. Finally, it is a surgical technique – the bypass – which is shown to be the most effective for the treatment of diabetes. In the group of patients who had a bypass, two-thirds of them had managed to normalize their blood sugar levels, 5 years after the operation and without any medication.
The bypass, the best technique against diabetes
“This study confirms that bariatric surgery, and in particular bypass, has a very high efficacy in the remission of diabetes,” says Professor Arnaud Basdevant, endocrinologist at the CHU de la Pitié-Salpêtrière in Paris. A previous Swedish study had already shown that the effects of this surgery on diabetes were maintained 10 years after the operation ”. If the interest of bariatric surgery is no longer debated on obese diabetics, there are still questions unanswered. First of all, “is it legitimate to offer this type of surgery to patients with less excess weight? asks Professor Basdevant. Currently, we do not offer a bypass below a BMI of 35. ”Some preliminary studies suggest that this would be of interest but they do not allow to decide. Then, is it possible to know in advance which diabetics will benefit the most from this surgery? The question is far from trivial given the side effects of bariatric surgery.
Listen to Prof. Arnaud Basdevant, endocrinologist at the CHU de la Pitié-Salpêtrière in Paris: “It is a surgery that is not at all trivial. The death rate is 1 in 5 per 1000.”
Doctors know that 60 to 70% of diabetics will go into remission thanks to this procedure. But what is the profile of these so-called “responder” patients to surgery? Until now, nothing really allowed to answer this question. But, British researchers have just developed a statistical tool that would allow them to be selected. Several criteria come into play: the surgery is more effective in young patients, who therefore have less old diabetes, with a lower glycated hemoglobin level, and in those who have not received drug treatment and especially insulin. Finally, the weight before the operation is not a predictor of the outcome of the surgery. The most obese are no more in remission from their diabetes than patients with a lower BMI. These results go broadly against current practice.
Listen to Professor Arnaud Basdevant: “We tend to wait before offering this surgery until the diabetes is really very serious and the patients are very obese.”
Indeed, specialists are hesitant for the moment to offer bariatric surgery – which presents significant risks – to patients whose diabetes is not too severe and for whom hygiene and dietary measures could be sufficient. But, this study published in the Lancet Diabetes-Endocrinology could lead them to review their strategy.
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