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| From NCDHHS.gov |
Good old Ben.
Essentially always true, this adage holds even more weight (pun intended) in light of an article that a friend brought to my attention recently regarding T2DM and the metabolic effects of Bariatric surgery.
The superlative and far-reaching benefits of bariatric / metabolic surgery for patients with Diabetes and obesity are quite well known. I have wondered for some time if this can translate into a prevention of sorts for these high risk patients, and if so, how could it be studied and presented in a way that was believable and evidence-based.
The article is actually not a newly published study, but rather from an article published in the NEJM in August of 2012, by a group of physicians that prospectively reviewed the Swedish Obesity Study data, looking for evidence of a preventative effect on the development of T2DM in Bariatric Surgery patients vs. obese matched controls who were treated with 'usual care'.
The authors found that bariatric surgery appeared to be markedly more efficient than usual care (diet, weight loss, and medicines) in the prevention of T2DM in obese persons.
Some more nitty gritty bullet points:
* Whereby both patient groups (surgery vs. usual care) had no evidence of T2DM at the start of the study (no reported DM meds, FBG <110, Random BG if measured <126), the bariatric surgery group developed Diabetes in 110 of the patients studies vs. 392 participants in the control group.
* The disparity in the rate of developing T2DM are even more noteworthy when it is noted that the surgery group had a significantly higher BMI and additional comorbidities vs. the non-surgical group.
* The mix of surgical procedures was based on what would be a percentage mix that would not be seen in this current era: Banding (19%), Vertical Banded Gastroplasty (69%), and Gastric Bypass (12%). Our current mix for cases is likely in the 60% Bypass / and near 40% for Sleeves, with a few percentage points for Bands. VBG's are not currently done all that often to my knowledge, but the procedure does involve gastric stapling and division, and therefore did confer some metabolic benefit.
* Running the numbers, the authors calculated a 78% reduction in the long term incidence of T2DM in obese patients.
* Among those patients who fit the definition of Impaired fasting glucose, bariatric surgery reduced the risk by 87%, and T2DM did not develop in 10 of 13 patients that underwent bariatric surgery. This effect was twice as large as observed with lifestyle interventions in moderately obese, prediabetic persons.
* This last point is probably the best takeaway action step that certainly mirrors other such information that is at the heart of this blog's purpose as a whole:
"Type 2 Diabetes is a progressive disease, and the ability to produce insulin declines with time.
Improvement of insulin sensitivity by means of weight loss may not be enough
to induce the remission of diabetes if the destruction of beta cells is advanced,
and the diabetes remission rate is
inversely related to the duration of diabetes at the time of bariatric surgery.
...this suggests that the disturbances of glucose metabolism might be treated early, even before T2DM is diagnosed."
I will let you read between the lines as far a that action step - one I suspect you have heard here many times before.
