Five-Year Data: Surgery Betters Medical Therapy for Diabetes (Part 3)

Gastric Bypass Has the Best Risk/Benefit Profile

Regarding surgery, there were no major long-term complications or mortality after surgery, according to Dr Rubino.

Patients who underwent biliopancreatic diversion did experience more nutrient-deficiency side effects, however, including osteoporosis and osteopenia.

"The nutritional side effects of gastric bypass were both milder and less frequent by comparison," reported Dr Rubino. "For this reason, we suggest that despite the greater percent of stable remission of hyperglycemia after biliopancreatic diversion, gastric bypass has a better risk-to-benefit profile."

He acknowledged that the study was small but noted that the findings suggest that surgery might reduce future complications of diabetes.

"Five years of remission or optimal glycemic control should have a lasting impact on a patient's risk to develop diabetes-related complications."

Weight Loss Is Not the Whole Story

In their discussion, Dr Mingrone and colleagues observe that weight loss alone cannot explain the effects of surgery on diabetes in their study.

Indeed, "when we looked at the two groups of surgical patients, we found that those with sustained remission had [lost] the same weight as those who relapsed," said Dr Rubino.

A statistically significant difference in remission rates between gastric bypass and biliopancreatic diversion was also evident, but there was no difference in weight loss between these two procedures, either.

"This suggests that weight change does not tell the whole story," he added.

It is thought that gastrointestinal surgery activates weight-independent mechanisms of diabetes control, possibly hormonal. The differences in anatomy resulting from different surgical procedures are thought to explain at least some of the variance in clinical effectiveness resulting from these operations.

These observations imply that bariatric surgery should not be reserved only for obese patients with a BMI over 35 kg/m2. Dr Rubino pointed out that "diabetes surgery should be based on disease-specific criteria; BMI is not one of those."

Ultimate Question Is Whether Bariatric Surgery Reduces Deaths

In conclusion, and acknowledging that surgery for type 2 diabetes is safe and effective in terms of glycemic control and reduced diabetes complications, Drs Pournaras and le Roux note in their editorial that "the ultimate question is whether diabetes surgery is associated with reduced mortality."

"Extension of follow-up in the trials already done and future well-designed and appropriately powered studies will provide some much-needed answers," they conclude.

The authors and editorialists declare no relevant financial relationships.

Lancet . 2015;386:964–973, 936–937. Abstract, Editorial

Reference information: www.medscape.com
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