Bariatric surgery promising, but not sole strategy, to reduce metabolic risk in T2D
Individuals with type 2 diabetes (T2D) who underwent bariatric surgery experienced significant reductions in several cardiometabolic risk factors up to 5 years post-surgery, according to a study from the UK. However, as the number of patients who achieved T2D remission was low, surgery alone may not be sufficient to manage metabolic risk factors.
“Bariatric surgery induced a significant sustained improvement of cardiometabolic risk factors in patients with T2D; however, a relatively low number of patients achieved T2D remission at 5 years,” said the researchers.
“Whilst the findings on microvascular complications are encouraging, these results raise the hypothesis that concurrent intensive medical therapy may be required to achieve more stringent and optimal cardiometabolic targets,” they said.
Researchers at the Imperial Weight Centre, Imperial College London, UK, set out to assess the long-term effects of bariatric surgery on T2D remission as per the ADA* and IDF** criteria and the microvascular complications of T2D namely retinal appearance and albuminuria. Their findings were presented as a poster at the recent IDF 2017 Congress.
Participants were 82 patients with T2D who underwent bariatric surgery, a majority of whom underwent Roux-en-Y gastric bypass (n=59).
Five years after undergoing bariatric surgery, 23 and 13 percent of patients achieved complete and partial T2D remission, respectively, as per ADA criteria, while 5 and 10 percent achieved metabolic state optimization and improvement, respectively, as per IDF criteria. [IDF 2017, abstract OP-0180]
Patients experienced significant reductions in weight loss 5 years post-surgery compared with prior to surgery (100.4 vs 133.5 kg), as well as reductions in HbA1c (6.3 percent vs 7.7 percent) and the number of glucose lowering medications required (1 vs 2; all p<0.0001). They also experienced significant improvements in HDL cholesterol levels (1.4 vs 1.1 mmol/L), triglycerides (1.3 vs 1.8 mmol/L), and both systolic (128 vs 142 mm Hg) and diastolic blood pressure (76 vs 84 mm Hg; p<0.0001 for all) 5 years post-surgery.
There was also a significant reduction in the albumin-creatinine ratio among the 62 patients with albuminuria at baseline (3.6 [5 years post-surgery] vs 7.1 mg/mmol [presurgery]; p=0.020).
Of the 24 patients with available retinal images, 54 percent experienced no change in retinal appearance, while 21 and 25 percent improved and worsened, respectively, 5 years post-surgery.
“[T]he relatively low rates of metabolic remission raise the need for validated protocols to assist clinicians in managing these patients more aggressively postoperatively to achieve optimum cardiometabolic risk factor control and hopefully further reduction in microvascular and macrovascular complications,” the researchers said.