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Bariatric Surgery May Improve Blood Glucose Control

Bariatric surgery helps type 2 diabetes patients to lose more weight and provides better long-term blood glucose control than medications combined with lifestyle interventions, according to a study supported by the National Institutes of Health.

About 38 million, or one in 10 Americans, have diabetes, which is often accompanied by high body weight. Some 62% of adults with type 1 diabetes and 86% of adults with type 2 diabetes are affected by overweight and obesity.

A new study published in JAMA suggests that bariatric surgery helped to achieve better long-term blood glucose control in people with type 2 diabetes compared to medical management plus lifestyle interventions.

“While there are many factors involved, and not all of them are completely understood, bariatric surgery typically results in greater weight loss that affects a person’s metabolic hormones, which improves the body’s response to insulin and ability to maintain healthy blood glucose levels,” Dr. Jean Lawrence, NIDDK project scientist, said in a statement.

What is bariatric surgery?

Bariatric surgery, also called metabolic or weight-loss surgery, involves making changes to the digestive system. There are three types of surgery:

Roux-en-Y gastric bypass involves creating a small pouch from the stomach and connecting it to the small intestine. This allows patients to reduce the amount of food they can eat.

When sleeve gastrectomy is performed, about 80% of the stomach is removed. Not only does it help to reduce food intake, but it also leads to decreased production of ghrelin, the appetite-regulating hormone.

Biliopancreatic diversion with duodenal switch (BPD/DS) involves performing a sleeve gastrectomy. Then, the middle section of the intestine is closed off, and the last part is directly attached to the first part of the small intestine. The separated section of the intestine is reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into this part of the intestine.

Surgery led to greater weight loss

The new study is a follow-up combining data from four independent single-center randomized trials conducted at clinical sites in the United States between May 2007 and August 2013.

The new study enrolled a total of 262 participants aged 18 to 65 with type 2 diabetes who were overweight or had obesity from the four original trials. Of these, 166 underwent one of three bariatric surgery procedures, while 96 participants were randomized to the medical/lifestyle management group.

At seven years, participants in the surgery group lost 20% of their body weight on average, compared to 8% in the medical/lifestyle group.

Moreover, bariatric surgery resulted in more significant improvements in blood glucose control, measured by HbA1c — a blood test measuring the average blood sugar levels over the past 3 months.

Fifty-four percent of participants in the surgery group achieved an HbA1c of less than 7% versus 27% of participants in the medical/lifestyle group.

Additionally, more participants with surgery achieved diabetes remission compared to participants in the medication/lifestyle group. The percentage of participants using diabetes medications in the surgery group dropped from 98% to 61%, yet remained largely unchanged in those managing the condition with medications and lifestyle interventions.

The results and differences between groups remained significant at 12 years.

Additional analyses suggested that bariatric surgery had important, beneficial effects on HbA1c and weight loss among participants with a body mass index between 27 and 34, falling under overweight and lower obesity ranges.

“These findings lend important information about the benefit of surgery in people with type 2 diabetes who fall short of the traditional, higher BMI threshold of 35 for bariatric surgery,” said Dr. Anita P. Courcoulas, chief of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh Medical Center and lead author of the study.

Although no differences in major adverse events occurred between the two groups, those who underwent surgeries were more likely to experience fractures, anemia, low iron, and gastrointestinal events. The researchers say fractures and anemia can be explained by nutritional deficiencies.

GLP-1 agonists weren’t examined

Although some participants were prescribed GLP-1 agonists as part of their medical management of diabetes, these novel drugs were not specifically examined in the study.

The increasingly popular type 2 diabetes and weight loss drugs, GLP-1 agonists, work by mimicking a hormone called glucagon-like peptide 1. The drugs stimulate insulin production, which helps lower blood sugar levels.

GLP-1 agonists can help lose up to 20% of body weight when combined with a healthy diet and exercise and are shown to be effective in controlling glucose levels. However, they are associated with severe gastrointestinal events, including stomach paralysis.

Bariatric surgery may have significant benefits in reducing body weight and achieving blood glucose control, although it carries the risk of fractures and anemia, among other side effects.

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