Remission of Type II Diabetes

Remission of Type II Diabetes After Gastric Bypass and Sleeve Gastrectomy

May 27, 2020

Act sooner than later to achieve diabetes remission with Bariatric Surgery

Those of us who practice bariatric surgery enjoy this field of surgery because we cure more diseases with one operation than any other field of medicine or surgery. 

One of the most important outcomes for a great many of our patients is the remission of type II diabetes mellitus (T2DM). 

By remission, we mean normal blood sugars without medication use. Throughout our training and careers as surgeons, we run into dead ends created by diabetes. Dead ends like the diabetic foot ulcer that won’t heal or cardiac muscle with microvascular damage. Bariatric surgery provides treatment with the highest remission rates for T2DM.

Remission of Type II Diabetes

Many studies over the years have demonstrated the effectiveness of gastric bypass and sleeve gastrectomy in the treatment of diabetes. 

The National Patient-Centered Clinical Research Network Bariatric Study

This year (March 4th, 2020) The National Patient-Centered Clinical Research Network Bariatric Study reported remission rates for 9,710 patients in 34 US health system sites.  The study found that T2DM remission rates at one year post-op were 59.2% for Roux en Y gastric bypass (RYGB) and 55.9% for sleeve gastrectomy (SG).  The T2DM remission rates at 5 years post-surgery were 86.1% for RYGB and 83.5% for SG.  Estimated relapse rates for those who had RYGB and SG were 8.4% and 11.0% at 1 year and 33.1% and 41.6% at 5 years after surgery. 

Cleveland Clinic Study

 A Cleveland Clinic study (also published this year: Diabetes Care. 2020 Mar;43(3):534-540. doi: 10.2337/dc19-1057. Epub 2020 Jan 23) determined that although some relapse of diabetes occurs, it should not be considered a failure of treatment as the trajectory and severity of the disease and its related cardiometabolic risk factors are changed favorably after bariatric surgery.

Many studies over the years have compared the effectiveness of bariatric surgery on the remission of diabetes to the effectiveness of non-surgical treatments.

The CROSSROADS Randomized Controlled Trial

A study I participated in called The CROSSROADS Randomized Controlled Trial was published in 2016 which demonstrated superior remission of diabetes (60% vs. 5.9%) 1 year after gastric bypass than after 1 year of intensive lifestyle (diet and exercise) changes.1   A number of other studies and reviews of literature have further demonstrated the superiority of Bariatric surgery in achieving diabetes remission2,3,4 .

 A trend in research outcomes has been the finding that the earlier you treat T2DM with RYGB or SG, the higher the remission rates.  Another 2020 publication has re-affirmed this finding:

Sweden Registry-Based Cohort Study

Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007-2015: A registry-based cohort study.

Jans A1, Näslund I1, Ottosson J1, Szabo E1, Näslund E2, Stenberg E1. PLoS Med. 2019 Nov 20;16(11):e1002985. doi: 10.1371/journal.pmed.1002985. eCollection 2019 Nov.

In this study, the authors demonstrated that the rate of T2DM remission was inversely associated with the duration of diabetes and highest among patients with recent onset and without the use of insulin. This means seeking surgical assistance for diabetes control earlier will result in better control of diabetes.

It is clear that the most effective short and long term treatment we have for achieving remission of diabetes is bariatric surgery.  My recommendation is that if you have diabetes, you should get a referral to and consult a bariatric surgeon regarding gastric bypass or sleeve gastrectomy.  These treatments along with lifestyle and diet changes offer your best hope for a diabetes-free future.

References:

  1. May 2016 Gastric Bypass Surgery vs Intensive Lifestyle and Medical Intervention for Type 2 Diabetes: The CROSSROADS Randomised Controlled Trial David E Cummings 1 , David E Arterburn 2 ,,  5 , Jeffrey T Landers 6 , Mario Kratz 3 , Karen E Foster-Schubert 7 , David R Flum 4 , et al., Randomized Controlled Trial
    Diabetologia Randomized Controlled Trial, 59 (5), 945-53.
  2. Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial
    Anita P Courcoulas 1 , Steven H Belle 2 , Rebecca H Neiberg 3 , Sheila K Pierson 1 , Jessie K Eagleton 1 , Melissa A Kalarchian 4 ,et al, JAMA 150 (10), 931-40., Oct 2015.
  3. Bariatric Surgery vs Lifestyle Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial
    Anita P Courcoulas 1 , James W Gallagher 1 , Rebecca H Neiberg 2 , Emily B Eagleton 1 , James P DeLany 3 ,et al, J Clin Endocrinol Metab, 105 (3), 2020 Mar 1.
  4. Bariatric surgery for obesity and metabolic disorders: state of the art.
    Nguyen NT, Varela JE. Nat Rev Gastroenterol Hepatol. 2017 Mar;14(3):160-169. doi: 10.1038/nrgastro.2016.170. Epub 2016 Nov 30.
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ABOUT THE AUTHOR

Jeffrey T. Landers, MD, FACS, FASMBS, LCDR-USN-RET is a board-certified surgeon specializing in Bariatric and Metabolic surgery at UW Medicine-Valley Medical Center Weight Loss Surgery Clinic in Renton, Washington. With over 22 years of experience, Dr. Landers is a verified surgeon through the Metabolic and Bariatric Surgery Quality Assessment and Improvement Program (MBSAQIP).