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Can Diabetes Be Surgically Cured? Long Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus
Stacy A Brethauer*, Ali Aminian*, Esam Batayyah*, Hector Romero-Talamas*, Hideharu Shimizu*, Andrea Zelisko*, Helen M Heneghan*, Bipan Chand*, Philip R Schauer
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH

OBJECTIVE(S): Although the impressive anti-diabetic effects of bariatric surgery have been shown in short-term studies, its durability is unknown.
METHODS: Metabolic parameters and clinical outcomes of 150 patients with type 2 diabetes (T2D) who underwent bariatric surgery during 2004-2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (HbA1c) <6% and fasting glucose (FBG)<100 mg/dL off diabetic medications.
RESULTS: At a median follow-up of 6 years (range 5-8) after surgery (Roux-en-Y gastric bypass, n=107; gastric banding, n=28; sleeve gastrectomy, n=15), a mean excess weight loss (EWL) of 43% was associated with a mean reduction in HbA1c and FBG of 1.1% and 43.6 mg/dL, respectively. Long-term complete and partial remission rate was 28% and 25%, respectively. Longer duration of T2D (p<0.001), higher
preoperative HbA1c (p=0.001), surgeries other than bypass (p<0.001), and lower long-term EWL (p=0.001) predicted lack of complete remission. Long-term recurrence of T2D after initial remission occurred in 14 patients (16%) and was associated with less EWL (p=0.007). Remission/improvement rate for co-existing dyslipidemia and hypertension was 53% and 69%, respectively.
CONCLUSIONS: Bariatric surgery can induce a significant and sustainable remission of T2D in obese patients and should be considered early in the course of the disease.




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