COMMENTARY

Anne Peters: The Year in Diabetes

Anne L. Peters, MD; Mark Harmel, MPH

Disclosures

December 10, 2013

In This Article

Bariatric Surgery Not Right for Everyone

The news that patients were either responders or nonresponders to bariatric surgery arrived as a bombshell at Obesity Week 2013, the joint annual scientific meeting of the American Society for Metabolic and Bariatric Surgery and The Obesity Society.

The Longitudinal Assessment of Bariatric Surgery (LABS)[22] study presented 3-year outcome data on 3 different procedures and found a variation in the amount of weight lost according to the surgery type, as well as variability in the effects on diabetes, cholesterol, and blood pressure. This indicates that there are many forms of obesity, and research is needed to determine the right surgical approach for each patient.

This conclusion is supported by new evidence from the long-running Swedish Obese Subjects study[23] that reported the need for surgery to take place early -- within 3 years of being diagnosed with diabetes for a significant impact on diabetes parameters. A retrospective review of 15 years of postsurgical data revealed that newly diagnosed patients (diabetes duration < 3 years) had a remission rate of 47% compared with 9% in the group with a longer duration ( > 3 years). This means that disease duration has a significant impact on the outcomes of surgery.

These findings are not surprising to me and make me feel less like the "jinx of bariatric surgery" because so few of my patients end up diabetes-free after their gastric bypass procedure. My practice consists of very few patients with shorter-duration disease; I tend to see the "sicker" individuals who have had diabetes much longer. When they undergo bariatric surgery, their glucose-related benefits are smaller, although there are other benefits associated with weight loss.

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