MedicalResearch.com Interview with:
Lene Ring Madsen, MD, Ph.d.
Medicinsk Afdeling Herning
Response: We know from previous studies that there is a significant chance of diabetes remission following Roux-en-Y gastric bypass, but most studies evaluate smaller cohorts of selected patients (e.g. from a single center or only patients covered by a specific type of insurance). By using Danish registries, which hold information on all Danish Citizens independent of social- or economic status and have complete follow-up, we wanted to evaluate the Roux-en-Y gastric bypass surgery (RYGB) in a real-world setting.
The main findings are that more than 70 % of patients with obesity (BMI>35 kg/m2) and type 2 diabetes treated by RYGB had their diabetes go into remission or every 6-month period in the first 5 years after the procedure. Out of those who were in remission within the first year of follow-up 27% had undergone relapse at 5 years.
The most important predictor of a patient not going into remission was if they required insulin to control their disease. Other factors included older age and higher starting HbA1c level. During the more than five years of follow-up, the risk of microvascular complications was 47% lower in the RYGB group than in the control population, with largest decreases in the risk of diabetic retinopathy and diabetic kidney disease. There was a smaller impact on the risk of macrovascular events, which were 24% lower among patients who had received bariatric surgery; however, this difference was not large enough to achieve statistical significance. The 90-day mortality was very low (<0.5%).
MedicalResearch.com: What should readers take away from your report?
Response: Our results add to the evidence that patients with obesity and type 2 diabetes should be offered bariatric surgery early on in the course of their disease, while there is still a great chance of diabetes remission. Furthermore, bariatric surgery lowers the risk of microvascular complications and the surgery is safe. Therefore, we as doctors should bare this kind of treatment for patients with obesity and type 2 diabetes in mind as a part of our toolbox in treatment of type 2 diabetes. Finally, because diabetes remission following RYGB is dynamic it is important that patients treated by RYGB comply to regular medical check-ups.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our study is a register-based study, so we can not conclude on mechanisms behind diabetes remission following the surgery, this topic is still being explored. Other forms of bariatric surgery is gaining popularity (e.g. gastric sleeve surgery), therefore, it would be interesting to evaluate the long term consequences of other surgery types on diabetes remission and diabetic micro-and macrovascular complications.
Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study
Diabetologia (2019). doi.org/10.1007/s00125-019-4816-2
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