PALM BEACH, FLA. – Bariatric surgery resulted in complete remission of type 2 diabetes and prediabetes in a group of mostly Hispanic and black patients.
Within 1 year of surgery, 100% of patients with those disorders experienced a normalization of fasting blood glucose and hemoglobin A1C, and they lost a mean of 40 kg, Dr. Alan Livingstone said at the annual meeting of the Southern Surgical Association. By the end of the 3-year follow-up period, all patients still had normal levels of blood glucose and insulin.
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"Uncontrolled type 2 diabetes is highly prevalent among ethnic minorities," said Dr. Livingstone, the Lucille and DeWitt Daughtry Professor and Chairman at Jackson Memorial Hospital, Miami. "Bariatric surgery helps to effectively treat these diverse minority groups and is a safe and effective option for permanent weight loss and chronic disease risk improvement in this population."
He reported on a cohort of 1,603 adult bariatric surgery patients, of whom 66% were Hispanic, 17% were black, and rest were other ethnicities. They were prospectively entered into a research database and then retrospectively studied.
"Minorities are at a particularly high risk for type 2 diabetes and its associated complications," Dr. Livingstone said. "While only 6% of whites have [the disorder], it’s present in 10% of Hispanics and 12% of blacks – a huge burden of disease."
The patients’ mean age was 45 years; most (77%) were female. The mean preoperative weight was 130 kg; the mean body mass index, 47 kg/m2.
Most of the group already had some insulin abnormality; 377 had diagnosed type 2 diabetes, 107 had undiagnosed type 2 (fasting blood glucose of more than 126 mg/dL), and 276 had prediabetes (fasting blood glucose of 100-125 mg/dL). Among those with elevated blood glucose, the mean HbA1c was 8%. The rest of the group had a normal insulin profile.
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Most patients underwent gastric banding (90%); the rest had gastric bypass. "The amount of weight loss was profound in the first year, as expected," Dr. Livingstone said. There was no significant difference in weight loss between the diagnostic groups. Body mass index also fell quickly, correlating with weight loss. By the end of the first 6 months, the mean BMI had dropped to 35 kg/ m2, and by the end of the first postoperative year, it was 30 kg/m2. Among the 57% of patients with full 3-year follow-up, there was no significant regain of weight.
Fasting blood glucose and HbA1c also improved rapidly and significantly in all those with preoperatively elevated levels. "It’s important to note how quickly this happened," Dr. Livingstone said. "Within the first year, all of these patients had normal fasting blood glucose and an HbA1c of 6% or below." Again, these values remained steady and in the normal range in the entire 3-year follow-up cohort. "This is a tremendous accomplishment," he said.
However, Dr. Bruce Schirmer of the University of Virginia, Charlottesville, cautioned that a 3-year follow-up period may not be long enough to proclaim bariatric surgery as a cure for type 2 diabetes in any population. "In mostly Caucasian populations, if you follow the patients for up to 5 years, you see that 15%-20%, at least, have some weight regain and with it, a return to diabetes. So to make this statement that there is no weight regain and no return to the disorder is a little premature."
Dr. Livingstone had no financial disclosures. Dr. Nestor F. De La Cruz-Munoz Jr., a coauthor and chief of laparoendoscopic and bariatric surgery at the University of Miami, is a consultant and proctor for Ethicon.