Sugar Camp

Diabetes Remission Seven Years After Gastric Bypass

Type 2 diabetes can be a brutal disease. It often, but not always, goes hand in hand with obesity. Thus, both of these conditions are rising throughout the world, exacting a terrible toll on human health. Once again, though, research tells us that a good option exists to turn this back for many people. A new study in JCEM tells us that seven years after gastric bypass, the operation can keep diabetes in remission.

Data from the LABS Study

The data for this analysis come from the LABS study – a huge NIH project to quantify long-term outcomes from bariatric surgery. Researchers examined the outcomes for 827 patients in this cohort with known diabetes status. They followed these patients for up to seven years and found that 57 percent achieved remission from diabetes. In 46 percent, the remission was complete. For another 11 percent, it was partial. Complete remission is an HbA1c less than 5.7 without meds. Partial remission means that value was between 5.7 and 6.5.

The odds of remission were better if people had surgery sooner after a diagnosis of diabetes. In other words, delay can be costly to one’s health. Lead author Jonathan Purnell explained:

“Consistent with similar studies, we find that a patient’s chances for achieving remission in their diabetes is greatest when they undergo surgery soon after diagnosis is established and when they need fewer medications. This is in contrast to current practice, which is often to wait until medical treatment has failed and/or they need multiple medications or insulin to maintain control.”

Shame for a Rational Choice

This gap between what is best for many patients and what they receive is hard to accept. But the reality is that very few – perhaps only one percent – of the patients who could benefit from gastric bypass actually receive it.

One of the biggest reasons for this is bias and stigma. Psychologist Gretchen Ames explains:

“One answer is that our society perpetuates a singular theme: individual choices related to nutrition and physical activity cause obesity. Another answer is the pervasive idea that bariatric surgery is unnecessary to achieve substantial weight loss. In other words, people who choose bariatric surgery don’t want to put in the hard work.”

Humans are very rational creatures. We can rationalize just about anything. But we should not tolerate the rationalization of systematically shaming and frustrating people who need care for obesity. It is simply wrong and costly to us all.

Click here for the study in JCEM, here and here for further perspective.

Sugar Camp, painting by Eastman Johnson / WikiArt

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December x, 2020

2 Responses to “Diabetes Remission Seven Years After Gastric Bypass”

  1. December 04, 2020 at 6:33 pm, Andrew Carey said:

    How is it ‘costly to us all’. In a market system the cost falls on the person who benefits. If you shun the levels of physical activity of the generations who developed western civilisation, that is fine if you like to live that way. Just don’t expect a subsidy. If you have a communicable disease or you’re blocking the road then absolutely I will whip out my cheque book, as there’s a cost to others. But unless someone is extremely gullible, stupid and lazy they are not going to catch obesity from their neighbour.
    I notice that the two fattest countries in the EU until 2020 are the two with NHS style health systems. That’s Malta and the UK. The SHI system effectively charges you for being obese, not by much, and the State picks up costs if you can’t afford the insurance premium. This might be a coincidence but I would rather not take my chances, thanks. Incentives matter.

  2. December 05, 2020 at 4:14 am, Ted said:

    Thanks, Andrew, for sharing your feelings about this. When people suffer ill health and cannot obtain care, economic productivity suffers, health complications mount, and healthcare becomes less and less efficient. Milken estimates that the economic impact of obesity and excess weight now exceeds $1.7 trillion. Loss of life, health, and productivity is indeed costly.