Gastric bypass surgery effective for weight loss, diabetes prevention for 12 years

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The mean change at 12 years in nonsurgery group 1 was −2.9 kg, compared with a mean change of 0 kg at 12 years in nonsurgery group 2.
The mean change at 12 years in nonsurgery group 1 was −2.9 kg, compared with a mean change of 0 kg at 12 years in nonsurgery group 2.

Roux-en-Y gastric bypass is effective for weight loss, as well as remission and prevention of type 2 diabetes, hypertension, and dyslipidemia for up to 12 years postsurgery, according to a study in the New England Journal of Medicine.

“The weight increase between the 6-year and 12-year follow-up was minimal, near-complete prevention of new-onset type 2 diabetes was observed, and the remission rate of type 2 diabetes 12 years after surgery was 51%,” reported Ted D. Adams, PhD, MPH, from the University of Utah School of Medicine in Salt Lake City, and colleagues. “Substantial improvement was also seen in systolic hypertension and lipid levels.”

The researchers included 1,156 patients (aged 18 to 72 years) with severe obesity who were categorized into 3 groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group); 417 patients who sought but did not undergo surgery (nonsurgery group 1); and 321 patients who did not seek surgery (nonsurgery group 2). Subjects had no history of alcohol or narcotics abuse, they had not undergone bariatric surgery, and they did not have gastric or duodenal ulcers, a myocardial infarction within the previous 6 months, or active cancer within the previous 5 years.

The investigators performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to determine the presence of type 2 diabetes, hypertension, and dyslipidemia. The percentage of original weight that was lost and the incidence and remission rates of type 2 diabetes, hypertension, and dyslipidemia among the survivors at 12 years were the primary end points. At 12 years, the follow-up rate was greater than 90%.

Dr. Adams' group found that the adjusted mean change from baseline in body weight in the surgery group was −45.0 kg at 2 years, −36.3 kg at 6 years, and −35.0 kg at 12 years. The mean change at 12 years in nonsurgery group 1 was −2.9 kg, compared with a mean change of 0 kg at 12 years in nonsurgery group 2.

Regarding patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 in the surgery group versus nonsurgery group 1 and 0.09 for the surgery group versus nonsurgery group 2. In addition, the surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia, compared with those in nonsurgery group 1.

“Remission of type 2 diabetes was much more likely if the Roux-en-Y gastric bypass occurred before the onset of treatment with insulin, presumably owing to the ability of partially viable beta cells to improve their function,” stated the researchers. “Clinical variables related to metabolic health (glucose levels, glycated hemoglobin levels, systolic blood pressure, and lipid levels) as well as remission and incidence rates of both hypertension and dyslipidemia were significantly more favorable in the surgery group than in the nonsurgery groups.”

Reference

Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377:1143-1155. doi: 10.1056/NEJMoa1700459

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