Bariatric surgery outcome better in early-onset diabetes

By David Douglas

NEW YORK (Reuters Health) - Bariatric surgery is associated with better and more long-lasting glycemic control in patients with early-onset type 2 diabetes than in those whose disease starts later, researchers have found.

Several trials have justified the use of bariatric surgery in mildly overweight patients with poorly controlled diabetes, write Dr. Wei-Jei Lee of Min-Sheng General Hospital in Taoyuan City, Taiwan, and colleagues in a paper online June 1 in JAMA Surgery.

However, the efficacy of the approach in patients with different ages of diabetes onset has not been examined. To do so, the team studied 339 patients with early-onset diabetes (starting at an age of less than 40 years) and 219 in whom diabetes began when they were older.

At one year, patients with early-onset diabetes achieved greater mean weight loss than those with in the late-onset group, although the difference was not significant.

However, significantly more of the early-onset group achieved complete remission (56.9% vs. 50.2%, p=0.02). At five years, this continued to be the case (65.3% vs. 52.4%, p=0.04), and by then the difference in weight loss had also become significant (30.4% versus 21.6%, p=0.002).

The overall five-year rate of prolonged, complete remission was 60%, which "is compatible with previous reports," the researchers say.

Age at bariatric surgery, duration of disease, and preoperative C-peptide level were independent predictors of remission (patients with C-peptide levels less than 1.0 ng/mL were excluded in order to select only patients with preserved islet cell function).

Dr. Ali Tavakkoli, co-author of an accompanying editorial, told Reuters Health by email, "Results of many randomized studies have confirmed the dramatic remission rates of diabetes after bariatric surgery and recent guidelines have emphasized the importance of including surgery in the treatment algorithm of type 2 diabetes."

"This study provides further evidence that surgery can be effective in type-2 diabetic patients, and may be more effective in those with young-onset type 2 diabetes," added Dr. Tavakkoli of Brigham and Women's Hospital in Boston.

"Timing of intervention is important however," he concluded. "The sooner that the surgical intervention is performed after diagnosis of diabetes, the better the surgical outcomes."

Dr. Lee did not respond to a request for comment.

SOURCE: https://bit.ly/1VMcMQK and https://bit.ly/1OdawR8

JAMA Surg 2016.