- Researchers report that bariatric
weight-loss surgery provides more long-term benefits for managing type 2
diabetes than lifestyle changes.
- They said that bariatric surgery also
improves cholesterol and triglyceride levels more effectively than medical
or lifestyle modifications.
- Currently, people with body mass index
readings of under 35 do not qualify for the surgery under most health
insurance company guidelines.
Bariatric surgery provides
more benefits than lifestyle
changes in managing type 2 diabetes,
according to a study completed at the University of Pittsburgh School of
Medicine and published today in the journal JAMA.
As
part of the research, participants with type 2 diabetes and obesity enrolled in
one of four randomized clinical trials completed
between May 2007 and August 2013.
The
participants underwent bariatric surgery or completed a medical and lifestyle
program based on established interventions known to reduce diabetes risk.
Interventions
included physical activity, nutrition
tracking, enhanced engagement with a healthcare team, stress management,
support groups, and medication. The trials occurred before the availability
of GLP-1
receptor agonist medications such as Ozempic for diabetes
management and weight loss.
The
researchers followed most of the participants for 12 years.
Findings in the weight
loss surgery and diabetes management study
The
researchers reported that bariatric surgery improved cholesterol and triglyceride levels
more effectively than medical or lifestyle
modifications. High cholesterol levels are a risk factor for heart disease.
Participants
who had the surgery also consistently had lower HbA1c levels,
indicating better blood sugar control,
at every follow-up point, despite starting the study with higher baseline
levels.
The
findings also included:
- At
the seven-year follow-up, 18% of participants achieved diabetes
remission, compared to 6% in the medical and lifestyle groups.
- At
the 12-year follow-up, participants who had surgery achieved an average of
19% weight loss, compared to slightly less than 11% in the medical and
lifestyle intervention group.
- Anemia, fractures,
and adverse gastrointestinal
symptoms, such as nausea and abdominal pain, were more common
in those who received bariatric surgery.
Participants
who did not achieve diabetic remission still had better blood sugar control and
used less diabetes medication than those who underwent lifestyle changes, the
researchers noted.
Reaction to the
bariatric surgery study
“In
my practice, I have seen patients who have weight loss surgery be able to
discontinue their diabetes, high blood pressure, and lipid-lowering
medications,” said Dr. Mir Ali,
a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss
Center at Orange Coast Medical Center in California who was not involved in the
study.
The
confirmation from the study results that bariatric surgery is more effective
than lifestyle interventions was not surprising to Dr. Anita
Courcoulas, the chief of the Section of Minimally Invasive Bariatric
and General Surgery at the University of Pittsburgh School of Medicine and one
of the authors of the study.
“What is new/novel is
that this is the largest study of its type and the length of follow up of 7 to
12 years is the longest,” she told Medical
News Today. “As well, this study
includes 37 percent of participants with BMI (body mass index) less than 35
with class 1 obesity and also finds long-term superiority of surgery over
medical/lifestyle treatment in this subset. These findings combined with
existing evidence lend very strong support for the use of bariatric surgery to
treat type 2 diabetes in people who cannot achieve glycemic control by
non-surgical means.”
Dr. Eliud
Sifonte, an endocrinologist at NYU Langone Medical Associates — West
Palm Beach and Delray Beach in Florida who was not involved in the study,
agreed.
“This
study confirms previously known findings showing the benefits of bariatric
surgery in those with metabolic diseases like diabetes and the efficacy of
early interventions in the progress of a diabetic,” he told Medical News Today.
“It also confirms the weight-centered approach to treatment of metabolic
derangements as compared to the traditional glucose-centric approach.”
“I
believe this confirmation could be key to helping some patients make the
decision to undergo bariatric surgery particularly since it presents the
possibility of remission, which is something many people with new onset
diabetes are interested in,” Sifonte added. “In my practice I typically discuss
bariatric surgery with those patients who have a history of obesity with
metabolic complications regardless of the typical threshold.”
BMI and bariatric surgery
The
researchers reported that the study’s results were consistent across weight
class groups, indicating that surgery was equally beneficial for people with
body mass indexes (BMI)
below and above 35 kg/m2.
Typically,
physicians do not recommend surgery for people below the 35 BMI level.
“BMI
is not an ideal marker of metabolic
disease,” said Dr. Mitchell Roslin, the chief of bariatric surgery at
Northwell Lenox Hill Hospital in New York who was not involved in the study.
“In fact, even high sugar misses a lot of people. All the big killers in the
West are linked to metabolic disease. This includes heart disease, cancer, and
neurological degenerative diseases.”
“Bariatric
surgery that provides a long-lasting control mechanism that better matches the
brain and GI tract, reduced hunger and prolonging satiety, is the best and
perhaps only treatment to provide long-term control of metabolic syndrome,”
Roslin told Medical News Today. “While obesity makes metabolic [disease] more
common, there are many with smaller BMI who have metabolic disease.
Additionally, as people age, metabolic disease increases.”
“Thus,
[I have] no reluctance to offer bariatric surgery to low BMI patients with
metabolic syndrome,” he added. “Like any therapy, [some] things will be
prevented and others, more likely. The advantage is a lower risk of heart
disease and cancer and [but] an increased risk of osteoporosis and
anemia. In my mind, this risk can be mitigated with follow-up after surgery,
diet, and exercise.”
The
researchers did not find differences in mortality or major cardiovascular
events in different weight class groups.
Insurance payments for
weight loss surgery
In
many cases, the final word on having bariatric surgery is not with the doctor
or the patient.
“The
decision is up to their health insurance company,” Mir told Medical News Today.
“Many times, the insurance companies are quite strict with approvals. People
with a BMI of under
35 often do not get approved. Sometimes, if there are other
health conditions, such as diabetes, we can ask them to approve payment. More
often, they deny the claim.”
Ali
said he has been working with other physicians to try to get the insurance
companies to lower the BMI threshold for weight loss surgery, but so far has
not had any luck.
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