Goodbye Diabetes Medication
Taking Antidiabetes Drugs Six Years After Surgery--
People with obesity and type 2 diabetes who had bariatric surgery were significantly less likely to need or start taking diabetes medication six years after bariatric surgery, according to a new study published online this month in JAMA Surgery.
Researchers analyzed data from 15,650 bariatric surgery patients in France in 2009, including 1,633 patients who were receiving diabetes treatment prior to surgery. They were compared to a comparable number of patients who were hospitalized for obesity but did not get bariatric surgery.
Nearly half (49.9%) of those who had bariatric surgery were able to discontinue diabetes treatment, compared to only 9 percent in the control group. For the surgical patients who were unable to discontinue treatment, 40 percent of those using insulin before surgery, were able to switch to another treatment, and 57 percent were able to move from dual therapy to monotherapy or no diabetes treatment.
In the study, gastric bypass was the most effective procedure. These patients were about
17 times more likely to discontinue diabetes medications than nonsurgical patients. Patients who had sleeve gastrectomy and adjustable gastric banding were about seven times and four times more likely, respectively. Just over one percent of patients with no diabetes initiated antidiabetes medication after surgery, compared to 12 percent in the non-surgical group.
“We can hypothesize that sustainable weight loss can protect patients from disease directly associated with morbid obesity such as type 2 diabetes, which is a serious chronic disease that has become more prevalent all around the world,” lead study author Jeremie Thereaux, MD, PhD of La Cavale Blanche University Hospital and the University of Bretagne Occidentale in Brest, France, told Reuters Health. “Bariatric surgery should be considered as an effective treatment of type 2 diabetes in patients suffering from morbid obesity.”
In an invited commentary to the study, bariatric surgeon, Michael Gagner, MD, FRCSC from the Herbert Wertheim School of Medicine, Florida International University in Miami and the Hôpital du Sacre Coeur, Montreal, Quebec, Canada, posits, “Is this the beginning of a battle of giants, a Titanesque clash between a pharmaceutical industry of billions of dollars that protects its interests vs a much smaller surgical devices group?”
Dr. Gagner wrote that $38.8 billion is spent on antidiabetes medication in the United States alone, an amount he says “would have surgically treated an astonishing 1.3 million patients.” According to the American Diabetes Association, 30.3 million Americans had diabetes, and 84.1 million had prediabetes in 2015. The ADA estimates that 1.5 million are diagnosed with diabetes every year in the United States.
“The evidence supporting metabolic and bariatric surgery for type 2 diabetes in patients
with obesity is overwhelming, yet surgery remains underutilized in this population,” said
Samer Mattar, MD, president of the American Society for Metabolic and Bariatric Surgery (ASMBS). “We need to change that.”
According to the ASMBS, only between 1 and 2 percent of surgically eligible patients in the U.S. have bariatric surgery each year.