MedWire News: Research shows that Type 2 diabetes patients who undergo bilio-pancreatic diversion (BPD) have significant improvements in diabetes, renal, and cardiovascular outcomes at 10 years compared with those who receive conventional diabetes therapy.
Weight loss surgery of various types can lead to significantly improved prognosis or resolution of diabetes, as previously reported by MedWire News, but few studies have collected data on long term outcomes for these patients.
Geltrude Mingrone (Catholic University, Rome, Italy) and colleagues followed-up 50 consecutive obese (body mass index [BMI] >35 kg/m2) patients, aged 25-60 years, with newly diagnosed Type 2 diabetes who underwent BPD during 1998-1999 (n=22) or who were treated with conventional therapy (controls; n=28).
The participants were followed-up for 10 years until 2009 for diabetes-related, renal, and cardiovascular outcomes.
All surgical patients went into diabetes remission within 1 year, which was maintained until study completion. Only 45% of the control group achieved diabetes resolution by the end of the study.
Regarding renal outcomes, the team reports that glomerular filtration rate was significantly increased in the surgical compared with the medical arm at 10 years, by 13.6% versus -45.7%. Hypercreatininemia was also lower in BPD patients than controls, at 9.0% versus 39.3%. In addition, all surgical patients recovered from microalbuminuria, whereas most control patients with microalbuminuria progressed to macroalbuminuria.
Cardiovascular outcomes were significantly better in the BPD than the control group at 10 years, as 20-year risk for coronary heart disease was 22% in the control group and 5% in the BPD group. Four cardiovascular events (three myocardial infarctions, one stroke) occurred over the follow-up period, but these were all experienced by control group patients.
"This study indicates that metabolic surgery represents a favorable option in the treatment of Type 2 diabetes, at least in subjects with severe obesity," say the researchers.
"In particular, it shows that renal and cardiovascular complications are dramatically reduced in the surgical group, indicating long-term benefits of metabolic surgery on diabetic complications."
They conclude in the journal Diabetes Care: "This observation is particularly relevant because it has been shown that the attainment of an optimal glycemic control is not the major factor in reducing the risk of coronary events in Type 2 diabetic subjects."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
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