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 Patients in the study had what’s known as type 2 diabetes, in which
sugar levels in the blood rise too high because the body can’t use
or make enough of the hormone insulin to convert food into energy.
After the weight-loss operations, some patients saw their diabetes
go into remission, which can occur when blood sugar falls back to a
healthy level. Patients who experienced remission were 29 percent
less likely to develop complications of diabetes like eye, kidney
and nerve damage than their peers who never had a remission, the
study found.
For each year patients stayed in remission without a diabetes
relapse, their risk of these complications was reduced by another 19
percent compared to their peers who never experienced remission, the
study also found.
“Even small periods of remission could lead to less disability later
in life,” lead study author Karen Coleman, a researcher at Kaiser
Permanente in California, said by email.
To understand the connection between diabetes remission and eye,
kidney and nerve damage, Coleman and colleagues analyzed data on
4,683 adults with diabetes who had bariatric surgery from 2001 to
2011.
At the start of the study, patients were 47 years old on average,
and most were extremely obese. About 44 percent had unhealthy blood
sugar levels, and more than 70 percent had other medical problems
like high blood pressure or high cholesterol.
One year after surgery, 9.5 percent of the patients had damage to
the small blood vessels in the eyes, kidneys and nerves of the hands
and feet. By three years, this went up to 21 percent and at seven
years it reached almost 41 percent.
Most of this so-called microvascular disease involved damage to the
retina of the eye, which affected 37 percent of patients seven years
after surgery.
By contrast, just five percent had kidney damage at seven years and
2 percent had nerve damage.
Older patients were more likely to develop these complications after
surgery than younger people, the study also found. People who had
diabetes for a longer time prior to their operations were also more
likely to have microvascular disease afterward than their peers who
had not lived with diabetes for as many years before surgery.
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Blood vessel damage tied to diabetes can lead to blindness, kidney
failure, impotence and foot disorders that may eventually require
amputations, Rachel Batterham, an obesity researcher at the
University College of London who wasn’t involved in the study, said
by email.
Because the study was observational and everyone had weight-loss
surgery, the results don’t prove that bariatric procedures cause
remission of diabetes, the authors note.
“Even a temporary remission is important as this study demonstrates
that bariatric surgery can reset the clock in terms of reducing
long-term microvascular disease secondary to diabetes,” Dr. Manish
Parikh, director of bariatric surgery at Bellevue Hospital Center in
New York said by email. He wasn’t involved in the study.
While it’s possible some patients with diabetes might achieve
remission without surgery, the study adds to evidence suggesting
that bariatric procedures may offer patients some benefits beyond
just weight loss, said Ted Adams, a researcher at Intermountain
Healthcare and the University of Utah in Salt Lake City who wasn’t
involved in the study.
“Long-term risk reduction in eye, nerve and kidney complications
shown in bariatric surgery patients even when their diabetes
remission following surgery has been temporary may be explained at
least in part by additional antidiabetic mechanisms beyond the
effects of weight loss or reduction in food intake,” Adams said by
email.
SOURCE: http://bit.ly/1WMR7ZX Diabetes Care, online June 6, 2016.
[© 2016 Thomson Reuters. All rights
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