Gastric Bypass Surgery for Mild Obesity in Diabetics

Gastric Bypass Surgery for Mild Obesity in Diabetics

In 2003, a study of more than 1,000 patients who underwent gastric bypass found that one-third of those with diabetes at baseline had normal blood sugars after their surgery and didn’t need medication when they were discharged from their surgical hospitalization. This finding sparked further exploration into the effects of gastric bypass surgery on weight-independent, antidiabetes mechanisms. Testing a New Population In Diabetes Care, my colleagues and I had a study published that explored the use of Roux-en-Y gastric bypass (RYGB) as a primary modality to treat type 2 diabetes in patients for whom weight loss was not the primary objective. When we began the study, clinical observations had suggested that diabetes remits in about 80% of patients who undergo gastric bypass. What we didn’t know was the durability of that effect or what the outcomes would be in patients who weren’t severely obese. In our analysis, we selected 66 consecutive patients with type 2 diabetes who were mildly obese (BMI between 30 kg/m2 and 35 kg/m2) to undergo RYGB. These patients were prospectively studied for up to 6 years. At baseline, they had an average A1C of 9.7% despite being on insulin or at least two diabetes medications. At 6 months after RYGB, the average A1C level decreased to 6.5% and continued to decrease to 6.1% at 6 years, with 100% follow-up in this cohort. At the latest follow-up, 88% of patients had achieved diabetes remission, which was defined as having an A1C of 6.5% or less and being off all diabetes medications. We also found that â-cells were nearly five times more sensitive to blood sugar, on...

The Effect of Slightly Elevated Albumin

Any degree of measurable albuminuria appears to bear significant cardiovascular risk among normoalbuminuric patients with type 2 diabetes, according to results of a small study. Albuminuria levels of 1 to 2 μg/min were significantly associated with increased risk when compared with albuminuria less than 1 μg/min. Abstract: Journal of the American Society of Nephrology, August 30, 2012...