Remission of Diabetes Post-Bariatric Surgery May Not Last

—By Ethan Covey

Remission of diabetes after bariatric surgery may only be a short-term outcome, according to a new study from Montefiore Medical Center. In the analysis, researchers noted a linear relationship between postsurgical weight gain and an increase in levels of hemoglobin A_1c.

“Diabesity is the term to describe the common coexistence between diabetes and obesity, and is currently considered an epidemic worldwide,” commented Nicholas Waler, MD, a resident at Montefiore Medical Center, in New York City.

Although bariatric surgery has been shown to be successful in weight reduction and addressing comorbid conditions such as type 2 diabetes and cardiovascular disease, limited studies have explored whether these effects last.

To do so, Dr. Waler and his colleagues conducted a retrospective cohort study looking at the long-term effects of bariatric surgery on A_1c levels. They utilized data from Montefiore’s Clinical Looking Glass (CLG) program to survey patients who underwent gastrectomy from January 2010 through the end of 2014. A total of 315 patients were identified who had a recorded hemoglobin A_1c level before and three to four years after surgery. This group was analyzed and divided into three categories: those who had weight gain from baseline; those with a minimal decrease in BMI from baseline; and those with a moderate decrease in BMI from baseline. “Overall, there was a 9% decrease in the median A_1c value and 20% decrease in median BMI value,” Dr. Waler said, “Additionally, there was a roughly 50% decrease in number of patients whose A_1c value was greater than 6.5.”

The team noted a much higher percentage of A_1c change toward worsening in patients who had been on insulin therapy both before (43%) and after surgery (30%).

Looking specifically at the relationship between A_1c levels and BMI in the insulin-treated patients, the results were not statistically significant.

“We found that while the trend for decrease in A_1c with increase in weight loss was still prevalent, there was not a statistical significance, suggesting that insulin resistance may somehow attenuate the benefit of weight loss in relation to the percent change in A_1c,” Dr. Waler said.

Dr. Waler noted that moving forward, there may be opportunities to adjust the support that diabetic patients receive after bariatric surgery, in an effort to better manage their health long term.

“Oftentimes these patients attend multidisciplinary clinics in order to be optimized for surgery and improve outcomes postoperatively, so possibly these patients who are on insulin therapy preoperatively may benefit from continuing multidisciplinary support postoperatively, since the weight loss alone from our data does not have significant decrease in hemoglobin A_1c,” he said.