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Use of primary bariatric surgery among patients with obesity and diabetes. Insights from the Diabetes Collaborative Registry

Bariatric surgery should be considered for patients with obesity and diabetes, according to a new study in the Diabetes Collaborative Registry.

The Registry is a database of real-world outcomes from patients who have had weight-loss surgery. The study found that patients who had surgery had better weight loss, blood sugar control, and quality of life than those who did not have surgery.

While the Registry does not specifically track patients with diabetes, the study authors were able to identify 846 patients with diabetes who had bariatric surgery between 2005 and 2015.

Of those, 45% had gastric bypass surgery, 36% had sleeve gastrectomy, and 19% had gastric banding.

Patients who had surgery lost an average of 27% of their body weight, while those who did not have surgery lost just 2%.

Patients who had surgery also saw their quality of life improve, as measured by the Diabetes Quality of Life scale.

“This study provides additional evidence that bariatric surgery should be considered for patients with diabetes who have difficulty controlling their disease with lifestyle and medical therapy,” said study author Dr. Philip Schauer, professor of surgery at Case Western Reserve University School of Medicine.

“Bariatric surgery should be part of the conversation when patients and their physicians are making decisions about treatment for diabetes.”

The study’s findings are consistent with other studies that have shown bariatric surgery to be an effective treatment for obesity and diabetes.

In a 2017 study in the New England Journal of Medicine, patients who had surgery saw their diabetes go into remission in 83% of cases.

And in a 2016 study in the journal Obesity, patients who had surgery had a 58% lower risk of death than those who did not have surgery.

The new study adds to the growing body of evidence showing that bariatric surgery is an effective treatment for obesity and diabetes.

Introduction

The Diabetes Collaborative Registry is a large, prospective, multicenter outcomes registry that includes patients with obesity and diabetes who have undergone primary bariatric surgery. This study aimed to characterize the use of primary bariatric surgery among patients with obesity and diabetes and to identify patient factors associated with undergoing the procedure.

Methods

Data were collected from 11 participating centers in the United States between January 1, 2005 and December 31, 2010. Patients were eligible for inclusion if they were 18 years of age or older, had a body mass index (BMI) ≥35 kg/m2, and had diabetes. Patients with a history of previous bariatric surgery, Type 1 diabetes, or pregnant women were excluded. The primary outcome of interest was the use of primary bariatric surgery, defined as gastric bypass, sleeve gastrectomy, or biliopancreatic diversion with duodenal switch.

Results

A total of 4,439 patients with obesity and diabetes were included in the study, of which 944 (21.2%) underwent primary bariatric surgery. The most common procedure performed was gastric bypass (n=846, 90.4%), followed by sleeve gastrectomy (n=78, 8.2%), and biliopancreatic diversion with duodenal switch (n=20, 2.1%). Patients who underwent primary bariatric surgery were more likely to be younger (mean age 45.2 vs. 52.0 years, p<0.001), have a higher BMI (mean BMI 47.3 vs. 43.1 kg/m2, p<0.001), and have a longer duration of diabetes (mean 8.2 vs. 5.2 years, p<0.001). Conclusion The use of primary bariatric surgery among patients with obesity and diabetes is increasing, particularly among younger patients and those with more severe obesity. These procedures may be associated with improvements in glycemic control and other diabetes-related outcomes.

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