title: Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors.
  
  
  BACKGROUND
  Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown.
  
  
  METHODS
  Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed.
  
  
  RESULTS
  At a median follow-up of 6 years (range: 5-9) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% ± 1.5% to 6.5% ± 1.2% (P < 0.001) and FBG from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P < 0.001). Long-term complete and partial remission rates were 24% and 26%, respectively, whereas 34% improved (>1% decrease in A1C without remission) from baseline and 16% remained unchanged. Shorter duration of T2DM (P < 0.001) and higher long-term EWL (P = 0.006) predicted long-term remission. Recurrence of T2DM after initial remission occurred in 19% and was associated with longer duration of T2DM (P = 0.03), less EWL (P = 0.02), and weight regain (P = 0.015). Long-term control rates of low high-density lipoprotein, high low-density lipoprotein, high triglyceridemia, and hypertension were 73%, 72%, 80%, and 62%, respectively. Diabetic nephropathy regressed (53%) or stabilized (47%).
  
  
  CONCLUSIONS
  Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.
authors.affiliation: *Bariatric and Metabolic Institute and †Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH; and ‡Department of Surgery, Loyola University, Chicago, IL.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.forename: Héctor
authors.initials: H
authors.lastname: Romero-Talamás
authors.forename: Esam
authors.initials: E
authors.lastname: Batayyah
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mackey
authors.forename: Laurence
authors.initials: L
authors.lastname: Kennedy
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Kashyap
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015415:Biomarkers / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
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