Is it safe to assume that Bariatric Surgery helps prevent type 2 diabetes?
A population based matched cohort study was recently performed on the effects of Bariatric surgery on type 2 diabetes . Compared were 2167 obese adults with no history of diabetes with 2167 controls matched for age, HbA1c , sex and BMI, who did not undergo bariatric surgery. It was determined that Bariatric surgery reduced the likelihood of type 2 diabetes by 80%. The median follow up here was 2.8 years with a maximum of 7 years.
This is coherent with the findings of the Swedish Obese Subjects(SOS) study which had individuals followed up for 15 years. The important bit is that the present study provides information on contemporary bariatric procedures like laparoscopic adjustable banding , gastric bypass and sleeve gastrectomy. The SOS study was performed on the now out dated vertical banded gastroplasty . The present study made use of data from a UK database while the data for the SOS study was gathered prospectively. Although the best matching efforts were made on the present study, the patients and controls differed widely in terms of medical monitoring. Not only did the controls from the database not go through substantial obesity treatment, they did not seemingly benefit from standard medical care either. Though being obese, 27% of controls had missing values for blood pressure and 68% had their cholesterol data missing. This is in comparison with 1% and 26% respectively, of bariatric surgery patients. The missing data confirms the fact that many doctors do not see obesity as a disease. On the other hand, bariatric surgery patients who were treated by the most advanced means against obesity are clearly a select group of individuals who were monitored closely as claimed by the present study.
The present study does not mention how bariatric surgery affects glucose metabolism and hence the incidence of de-novo type 2 diabetes. Weight loss is a well accepted mechanism of diabetes remission with more weight loss increasing the chance of remission. Likewise, in people without diabetes, weight loss reduces the risks of developing type 2 diabetes. This should throw light on why the present results show that risk of developing diabetes in bariatric patients that were the least obese is only slightly smaller than matched records. The incompleteness of the data however prevents the adequate establishment of a possible link between minor amounts of weight loss, weight regain and development of type 2 diabetes. Also, the present study in question did not address whether factors outside weight loss affected the development of de-novo type 2 diabetes. The follow up was short – less than 4 years. This is key as most individuals regain weight over time, post bariatric surgery ; an important consideration in the context of diabetes. In the study, no direct link was established between relapse of diabetes and weight regain and thus it was other factors that seemed to affect the natural occurrence of type 2 diabetes after bariatric surgery.
Although the study takes us a step closer to confirming the effects of bariatric surgery on the occurrence of de-novo type 2 diabetes, many questions are still to be answered and more evidence is needed to convince endocrinologists about the nature of this effect.
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