Bariatric Surgery: From Treatment to Prevention of Diabetes?

You've come a long way, baby!  Bariatric surgery used to be extremely high risk and fraught w/complications, not that it still isn't.  But with the advent of laparoscopic adjustable banding techniques, the risk is much lower.  Moreover, in just over four years, we've moved from remission of diabetes to a case-control study published today in the New England Journal of Medicine demonstrating possible prevention of diabetes!

Just to be clear, as the editorialist noted, this study didn't so much prove prevention as it did lower risk of developing diabetes.  A fine distinction to be sure, but one that's absolutely necessary.  After all, when the authors followed for 15 years 1,658 Swedish patients who underwent some sort of bariatric surgery to 1,771 obese matched controls, none of whom had diabetes at baseline, they noted that the conversion rate to diabetes was only 6.8 cases per 1,000 person-years in the former compared to 28.4 cases per 1,000 person-years in the latter.  That's a roughly 75% lower rate but certainly not complete "prevention" if you will.  Nonetheless, it's a very exciting, albeit expensive & drastic development.

Clearly, these findings are not flukes.  A March 2009 review & meta-analysis again demonstrated improvement, if not resolution, of the majority of patients w/diabetes, while in April of this year, a randomized, non-blinded single-center study demonstrated similar findings over 12 months.  A second study in that same issue of NEJM also came to the same conclusion.  But, do note that these all demonstrated better control, even "curing" diabetes, while the current study demonstrated possible prevention.

So let's look at the big picture.  Weight loss appears to be key.  After all, that's the obvious result of bariatric surgery.  But remember NBC's Biggest Losers?  The contestants achieved similar results (resolution of diabetic & hypertensive parameters) after just 5 weeks of intense physical activity, without any surgical risk!  Granted, an economist will need to compare total costs of surgical intervention vs pulling someone out of his/her environment for up to 6 months at a time.  Bottom line: weight loss is key.

Follow @alvinblin
Tweet