Literature
Clinical Pearls & Morning Reports
Published September 20, 2017
Adams et al. recently published the 12-year follow-up results of a long-term observational, prospective study of Roux-en-Y gastric bypass in the United States. The authors compared changes in weight and the incidence and remission rates of type 2 diabetes, hypertension, and dyslipidemia in patients with severe obesity who underwent Roux-en-Y gastric bypass with respective findings in two groups of patients with severe obesity who did not undergo bariatric surgery. Read the latest NEJM Original Article.
Clinical Pearls
Q: How durable is the postsurgical weight loss achieved with Roux-en-Y gastric bypass?
A: In the study by Adams et al., despite a wide variation in change in body weight across the sample, 360 of 387 patients (93%) in the surgery group maintained at least a 10% weight loss from baseline to year 12, 271 (70%) maintained at least a 20% weight loss, and 155 (40%) maintained at least a 30% weight loss. Only 4 of 387 patients (1%) in the surgery group had regained all their postsurgical weight loss.
Q: How effective is Roux-en-Y gastric bypass in reducing the likelihood of developing type 2 diabetes?
A: In the study by Adams et al., the 12-year incidence of type 2 diabetes was 3% (8 of 303 patients) in the surgery group, as compared with 26% (42 of 164 patients) in nonsurgery group 1 and 26% (47 of 184 patients) in nonsurgery group 2.
Morning Report Questions
Q: How likely is Roux-en-Y gastric bypass to produce a remission of type 2 diabetes?
A: In the surgery group followed by Adams et al., remission of type 2 diabetes was observed in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. Of the 62 patients in the surgery group who had initial remission at 2 years and had 12-year follow-up data, 69% remained free of type 2 diabetes at 12 years. Successful remission of type 2 diabetes was strongly predicted by baseline medication status. Remission of type 2 diabetes at 12 years was observed in 16 of 22 patients in the surgery group (73%; 95% CI, 46 to 99) who had type 2 diabetes but had not been receiving antidiabetic medications at baseline, as compared with 24 of 43 patients with diabetes (56%; 95% CI, 35 to 77) who had been receiving only oral medications at baseline and 3 of 19 patients with diabetes (16%; 95% CI, −8 to 39) who had been receiving insulin (with or without additional oral antidiabetic medication) at baseline.
Q: Were there any deaths by suicide in the study by Adams et al.?
A: Deaths by suicide occurred only among patients in the surgery group or among patients in nonsurgery group 1 after they underwent bariatric surgery, a finding consistent with the 2-year and 6-year follow-up results of the study. The possible association of suicide and bariatric surgery was reviewed across 28 studies. The review showed that suicides, self-harm emergencies, or both were higher among patients who had undergone bariatric surgery than among persons in the general population, persons in control groups, and presurgical patients. Whether the increase in suicides is attributable solely to bariatric surgery itself or whether any large, sustained weight loss would also be associated with an increased risk of suicide is unknown. On the basis of the results of the current study and of other reports of increased self-harm after bariatric surgery, there is an apparent pressing, unmet need to better predict and prevent this uncommon but very serious sequela of bariatric surgery.