The Lancet: Cure type 2 diabetes! Metabolic surgery can completely reverse the condition for up to 10 years

Professor Francesco Rubino, chair of weight loss and metabolic surgery at King's College Hospital in London and one of the authors of the paper, said: "This study provides the strongest scientific evidence to date that type 2 diabetes is not necessarily a sexual development or irreversible.
" trial began about 10 years ago at a level 3 hospital in Italy and included 60 serious cases of type 2 diabetes between April 2009 and October 2011.
patients had more than five years of diabetes, poor blood sugar levels (HbA1c;7.0%) and a body mass index ≥35 kg/m2.
these patients were randomly grouped at 1:1:1 for drug plus lifestyle interventions or different metabolic surgery (gastric bypass surgery (RYGB) or bile pancreatic reflow (BPD).
's previously published results showed that two years after surgery, no patients in the drug treatment group achieved diabetes remission (without medication, HbA1c-lt;6.5% and perititucation blood sugar-lt;5.55 mmol/L lasted at least one year), while 75% of the gastric bypass surgery group and 95% of the bile pancreatic reflow group achieved remission, respectively.
follow-up five years after surgery, the proportion of patients who remained in remission in both surgical groups was 37% and 63%, respectively.
the results of a 10-year follow-up analysis to further analyze the durability of diabetes relief from metabolic surgery.
95 percent (57/60) of patients were still studying follow-up.
showed that 37.5 per cent (15/40) of all patients treated with surgery remained diabetic after 10 years.
the American Diabetes Association (ADA) in 2009, defining a "cure" of diabetes as a state of disease relief that lasts more than five years.
other words, the 15 patients were "cured" of diabetes.
specifically, 1 patient in the original drug group who later underwent surgery achieved 10 years of remission, and the 10-year remission rate in the gastric bypass surgery group and the bile pancreatic reflow group was 50% and 25%, respectively.
who had not been in remission for the first two years after the operation, and no cases had been remission since then.
patients who underwent gastric bypass surgery had a medium diabetes remission time of 5 years, and a medium diabetes remission time of 9 years in patients in the bile pancreatic transflow group, with the highest risk of recurrence in the first 5 years after surgery.
58.8% (20/34 cases) of patients who were remissioned in the two years after surgery had elevated blood sugar in follow-up follow-up, and the recurrence rates in the gastric bypass surgery group and the bilial pancreatic reflow group were 66.7% and 52.6%, respectively.
even so, all of these relapsed patients maintained stable blood sugar levels for 10 years after surgery: an average HbA1c 6.7%, with the exception of 1, all patients with recurrence had HbA1c-lt;7.0%.
all patients who underwent metabolic surgery, the overall 10-year improvement in blood sugar control was even more significant.
patients receiving medication, gastric bypass surgery and bile pancreatic refratic surgery, HbA1c decreased by 0.8%, 1.9% and 2.4%, respectively.
87.5% of patients in the metabolic surgery group achieved the control target of HbA1c-lt;7.0%, while the drug treatment group did not meet the target.
metabolic surgery also significantly reduced the overall metabolic risk of these patients, including weight and waist circumference, improved insulin resistance, lipids, cardiovascular risk, kidney function, and overall quality of life.
surgery also reduces the use of drugs for a variety of diseases, including those for diabetes, high blood pressure, and abnormal blood lipids.
notable, patients in the metabolic surgery group had a 93 percent lower risk of diabetes complications, including adverse events in the heart, kidneys and nervous system, compared to medication.
study found no unexpected risks associated with surgery.
patients in the bile pancreatic reflow group had higher frequency of serious adverse events, which were 2.7 times higher than in the drug treatment group, and there was no significant difference in the rate of serious adverse events in the gastric bypass surgery group and the drug treatment group.
currently, metabolic surgery has a strict adaptation in most countries, with less than 1% of surgical candidates eventually undergoing metabolic surgery.
, lead author of the paper and Professor Geltrude Mingrone, of King's College London, said: "These data confirm that metabolic surgery can be a cost-effective treatment and should be seen as a major treatment option for people with severe type 2 diabetes and obesity.
" in a commentary published in the Lancet at the same time, Professor Carel W le Roux of University College Dublin and Dr Alexander D Miras of Imperial College London point out that these important evidences are making up for our unknowns and will gradually change the attitudes of diabetes specialists and patients.
controlled trial data from previous metabolic surgery were usually followed by shorter follow-up periods, and the 10-year data were reassuring.
, and over the past 12 years, 12 other randomized controlled trials have shown consistent findings.
Now, the trial's strict and reliable definition of diabetes 'relief' and 'cure', as well as a comprehensive comparison of patients across groups, can help clinicians and patients make better decisions and change lives," he said.
the endless strengthening of insulin therapy, it is considered that the patient's compliance is insufficient, the effect of metabolic surgery is in sharp contrast.
" at the same time, the commentary also pointed out that the trial did not alleviate and relapse patients remind that for these patients, after metabolic surgery should also be strengthened in a timely manner sugar treatment, metabolic surgery should be used in a joint use with anti-sugar drugs when necessary.
we have a better option and don't have to throw away the original treatment.
[1] Geltrude Mingrone, et al., (2021). 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. The Lancet, DOI: [2] Alexander D Miras, Carel W le Roux. (2021). Metabolic surgery versus conventional therapy in type 2 diabetes. The Lancet, DOI: [3] Gastrointestinal surgery can be a cure for type 2 diabetes finds new long-term study. Retrieved January 22, 2020, from [4] Mingrone G, et al., (2012). Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med, DOI: 10.1056/NEJMoa1200111. [5] Mingrone G, et al., (2015). Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet, DOi: 10.1016/S0140-6736(15)00075-6.