Advertisement

Obesity Surgery

, Volume 26, Issue 8, pp 1814–1820 | Cite as

Long-Term Outcomes of Three Types of Bariatric Surgery on Obesity and Type 2 Diabetes Control and Remission

  • Dror DickerEmail author
  • Rina Yahalom
  • Doron S. Comaneshter
  • Shlomo Vinker
Original Contributions

Abstract

Background

Different bariatric surgeries have demonstrated different effectiveness for weight loss and glucose control in obese persons with diabetes, over a short follow-up time. The aim of this study was to compare weight loss, glucose control, and diabetes remission in individuals with type 2 diabetes, after three types of bariatric surgery: gastric banding (GB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB), with 5 years follow-up.

Methods

A retrospective study was conducted on bariatric surgeries performed during 2002–2011 in a large nationwide healthcare organization.

Results

Of 2190 patients, 64.8 % were women. The operations performed were 1027 GB, 1023 SG, and 140 RYGB. Mean BMI ± SD at baseline, 1 year postoperatively, and 5 years postoperatively were 43.5 ± 6.18, 37.1 ± 6.35, and 35.5 ± 6.48 for GB; 43.6 ± 6.42, 34.4 ± 6.08, and 35.3 ± 6.7 for SG; and 42.8 ± 5.81, 32.8 ± 4.9, and 34.1 ± 5.09 for RYGB. Mean HbA1c ± SD at baseline, 1 year postoperatively, and 5 years postoperatively were 7.6 + 1.58, 6.5 + 1.22, and 6.8 + 1.48 for GB; 7.7 + 1.63, 6.4 + 1.18, and 6.7 + 1.57 for SG; and 8.0 + 1.78, 6.3 + 0.98, and 7.04 + 1.42 for RYGB. At 1 year follow-up, 53.2 % had achieved remission; at 5 years, 54.4 %. Remission rates at 5 years were similar for the three surgeries. Five-year remission was inversely associated with baseline HbA1c and with treatment with insulin at baseline and positively associated with BMI.

Conclusions

For all three surgeries, diabetes remission was higher than the baseline after 5 years; mean BMI and HbA1c decreased considerably during the first year postoperatively and remained lower than basal values throughout follow-up. Early improvements were greatest for RYGB, though the advantage over the other operations diminished with time.

Keywords

Bariatric surgery Weight loss Diabetes remission Long-term follow-up 

Notes

Compliance with Ethical Standards

Since all data were obtained from medical records and no identifying information was included in any of the study documentations, informed consent from patients was not required.

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no competing interests.

References

  1. 1.
    Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980, systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980, systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.CrossRefPubMedGoogle Scholar
  3. 3.
    American Diabetes Association. Standards of medical care in diabetes-2015 abridged for primary care providers. Clin Diabetes. 2015;33(2):97–111.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Yu J, Zhou X, Li L, et al. The long-term effects of bariatric surgery for type 2 diabetes: systematic review and meta-analysis of randomized and non-randomized evidence. Obes Surg. 2015;25(1):143–58.CrossRefPubMedGoogle Scholar
  6. 6.
    Brethauer SA, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.CrossRefPubMedGoogle Scholar
  8. 8.
    Kim MK, Kim W, Kwon HS, et al. Effects of bariatric surgery on metabolic and nutritional parameters in severely obese Korean patients with type 2 diabetes: a prospective 2-year follow up. J Diabetes Investig. 2014;5(2):221–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Lakdawala M, Shaikh S, Bandukwala S, et al. Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30–35 kg/m2) Indian patients with type 2 diabetes mellitus. Surg Obes Relat Dis. 2013;9(3):370–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMedGoogle Scholar
  12. 12.
    Prevention or delay of type 2 diabetes. Diabetes Care. 2015; 38(Suppl. 1):S31–2.Google Scholar
  13. 13.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg 2015.Google Scholar
  14. 14.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256.e5.CrossRefPubMedGoogle Scholar
  15. 15.
    Jiménez A, Casamitjana R, Flores L, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256(6):1023–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24(5):1005–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Pham S, Gancel A, Scotte M, et al. Comparison of the effectiveness of four bariatric surgery procedures in obese patients with type 2 diabetes: a retrospective study. J Obes. 2014;2014:638203.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Ramón JM, Salvans S, Crous X, et al. Effect of Roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial. J Gastrointest Surg. 2012;16(6):1116–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Rhee NA, Vilsbøll T, Knop FK. Current evidence for a role of GLP-1 in Roux-en-Y gastric bypass-induced remission of type 2 diabetes. Diabetes Obes Metab. 2012;14(4):291–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623–30.CrossRefPubMedGoogle Scholar
  23. 23.
    Kashyap SR, Bhatt DL, Wolski K, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care. 2013;36(8):2175–82.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Jiao J, Bae EJ, Bandyopadhyay G, et al. Restoration of euglycemia after duodenal bypass surgery is reliant on central and peripheral inputs in Zucker fa/fa rats. Diabetes. 2013;62(4):1074–83.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Allen RE, Hughes TD, Ng JL, et al. Mechanisms behind the immediate effects of Roux-en-Y gastric bypass surgery on type 2 diabetes. Theor Biol Med Model. 2013;10:45.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Saeidi N, Meoli L, Nestoridi E, et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013;341(6144):406–10.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Zhang H, DiBaise JK, Zuccolo A, et al. Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci U S A. 2009;106(7):2365–70.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Panunzi S, De Gaetano A, Carnicelli A, et al. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis. Ann Surg. 2015;261(3):459–67.CrossRefPubMedGoogle Scholar
  29. 29.
    Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(3):254–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84. discussion 84–5.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Jiménez A, Ceriello A, Casamitjana R, et al. Remission of type 2 diabetes after Roux-en-Y gastric bypass or sleeve gastrectomy is associated with a distinct glycemic profile. Ann Surg. 2015;261(2):316–22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Dror Dicker
    • 1
    • 2
    Email author
  • Rina Yahalom
    • 3
  • Doron S. Comaneshter
    • 3
  • Shlomo Vinker
    • 2
    • 3
  1. 1.Department of Internal Medicine D, Hasharon HospitalRabin Medical CenterPetah TikvaIsrael
  2. 2.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Central HeadquartersClalit Health ServicesTel AvivIsrael

Personalised recommendations