Bariatric surgery allows most patients with advanced diabetes to maintain remission after 10 years

This article from the NEJM meta-Journal (NEJM Journal Watch) Bariatric Surgery for Advanced Diabetes: Many Patients Maintain Remission 10 Years Later treatment of advanced diabetes through weight loss surgery: Many patients remain 10 years after remission comment author: Bruce Soloway, MD In a In randomized trials, surgery is more effective than drug therapy in promoting alleviation and prevention of diabetes-related complications.

Observational studies suggest that bariatric surgery can achieve long-term remission of type 2 diabetes, but patients in these studies are usually relatively young and suffer from early or mild diabetes.

The researchers randomized 60 patients (age range, 30 to 60 years old) with type 2 diabetes mellitus for more than 5 years, and HbA1c (HbA1c) greater than 7.
0%.
The three groups received Roux- en-Y gastric bypass (RYGB), biliary-pancreatic bypass (BPD) or drug therapy.

In the previously published five-year data, the proportion of patients who received surgery and medications that achieved remission was half and zero, respectively; remission was defined as fasting blood glucose <100 mg/dL and HbA1c <6.
5 without medication.
% For at least 1 year (NEJM JW Gen Med Apr 15 2012 and N Engl J Med 2012; 366:1577).

In the newly published 10-year follow-up data, 15 of the 40 patients assigned to the surgery group still maintained diabetic remission (5 of the 20 patients in the RYGB group, and 10 of the 20 patients in the BPD group).

Among the patients assigned to the medication group, the only patient who achieved remission underwent surgery across the group.

No patient achieved remission 2 years after surgery.

Of the 34 patients who achieved remission within 2 years after surgery, 20 patients relapsed within 10 years after surgery, but these patients received less drug treatment to achieve an average HbA1c of 6.
7%.

Compared with patients receiving medical treatment, there are fewer diabetes-related complications in patients undergoing surgical treatment, but more digestive and metabolic complications (especially after BPD surgery).

Comment This study provides more evidence that "metabolic surgery" can achieve long-term remission of type 2 diabetes and reduce the long-term risk associated with diabetes.

Clinicians and patients with uncontrolled chronic diabetes may consider surgery.

Mingrone G et al.
Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial.
Lancet 2021 Jan 23; 397:293.
(https://doi.
org/10.
1016/S0140-6736(20)32649-0) Related reading NEJM Journal Watch The NEJM Journal Watch is published by NEJM Group.
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