Unlocking Diabetes Remission with Bariatric Interventions

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Bariatric surgery is a highly effective treatment for people with type 2 diabetes, especially for those with obesity, according to a recent systematic review. It can help patients lose weight and improve blood sugar control and often leads to diabetes remission by reducing stomach size and altering hormones.

The surgical intervention was also shown to reduce the risks associated with obesity-related health conditions, and patients frequently experienced improved mental well-being and increased quality of life.

As type 2 diabetes is linked to obesity and lifestyle factors, such as poor diet and inactivity, losing weight plays an important role in managing the condition. Although changes in diet, exercising more and taking medication can help achieve this goal, bariatric surgery is gaining attention for its ability to significantly reduce weight and keep it off among these patients. It’s also demonstrated its efficacy in improving insulin sensitivity and potentially obtaining remission.

“One of the most fascinating consequences of weight loss surgery is the possibility of complete or partial remission of type 2 diabetes,” wrote lead investigator Ahmed M. Mohamed, MBBS, associated with the James Cook University Hospital, United Kingdom. “This phenomenon is likely attributable to the profound metabolic alterations induced by the surgery, such as modifications in gut hormones like glucagon-like peptide-1 (GLP-1), shifts in bile acid metabolism, and alterations to the gut microbiome, all of which play a role in controlling glucose homeostasis.”

The review evaluated the efficacy of bariatric surgery in inducing type 2 diabetes remission and identified factors that influenced the outcomes of surgical interventions using a comprehensive database search. Their research measured the impact of surgery compared with nonsurgical interventions on diabetes in obese or severely obese patients aged 18 years or older. Investigators also examined the sustainability of remission, its impact on comorbidities, safety and complications, postoperative follow-up support, adherence to dietary and lifestyle changes, and quality of life improvements.

A total of 33 studies published between 2005 and 2024 were ultimately included in the analysis.

The Roux-en-Y gastric bypass (RYGB) method led to significant weight loss and improvements in diabetes symptoms, with 40% of patients achieving remission within a year in one study. Sleeve gastrectomy (SG) also showed effective results in reducing weight and blood sugar levels. However, adjustable gastric bands (AGB) exhibited the lowest rates of remission in comparison with the other two methods.

Long-term studies reported that the benefits of bariatric surgery can last for years, especially when combined with healthy lifestyle changes. For example, one study noted 70% of patients who achieve diabetes remission after surgery maintain it for at least five years. However, investigators noted commitment to a healthy diet and active lifestyle is critical for long-term success after bariatric surgery. Patients who participated in support groups and educational programs were also more likely to maintain weight loss and better manage their condition.

Younger patients and those who have had diabetes for a shorter period are more likely to experience remission after bariatric surgery. Additionally, patients with lower initial weight tend to have better outcomes compared with those with extreme obesity.

Surgical interventions also improved other health problems, such as high blood pressure, high cholesterol and sleep apnea. Patients often reported better quality of life after surgery, including improved mental health, less anxiety and increased physical activity.

Although complications from bariatric surgery are rare, a small number of patients experienced issues including nutrient deficiencies. Findings revealed careful monitoring and individualized care can help minimize these risks and ensure a safer recovery. Further, consistent follow-up care with medical professionals, including dietitians and psychologists, is essential for long-term success. Regular support helps patients stick to healthy lifestyle changes, improving their chances of maintaining remission.

“[This study] highlights bariatric surgery as a promising option for the treatment of type 2 diabetes, specifically in patients with obesity, which should encourage clinicians to consider not only its effects on body weight but also its use as a tool for achieving remission of diabetes,” investigators concluded.