Over the last decades, many modalities to prevent type 2 diabetes have been studied. Lifestyle changes, particularly if they result in weight loss, can be very powerful to prevent this condition. Of all of the medications studied, only metformin has so far been recommended to decrease the risk of developing diabetes in people who have prediabetes. Now, studies are coming out, showing that bariatric (obesity) surgery can be very powerful to prevent type 2 diabetes.
One such study, published recently in The Lancet (Diabetes & Endocrinology), looked at over 2000 patients who had bariatric surgery, and compared them to a group of matched patients who had not had obesity surgery. They found that, over a median of 2.8 years and a maximum of 7 years of follow up, patients who had bariatric surgery had an 80% lower risk of developing diabetes compared to people who had not had bariatric surgery.
Another recent study was a systemic review and meta-analysis that looked at the power of different interventions to prevent diabetes. In examination of studies of physical activity +/- diet, anti diabetic medications, obesity medications, and bariatric surgery, they found all of these strategies to be of benefit. Bariatric surgery stood out as being the most effective to prevent diabetes, with a 90% reduction in risk.
So the question then becomes, should we advocate for obesity surgery for the purpose of prevention of diabetes? Well, as for any treatment or prevention of any medical condition, it’s important to balance the benefits vs risks. Bariatric surgery is invasive, and the most successful modalities (gastric bypass and sleeve gastrectomy) are permanent procedures. These procedures have a long list of possible complications that need to be taken into consideration.
While bariatric surgery may be the best treatment option for some patients with obesity and existing type 2 diabetes, obstructive sleep apnea, severe high blood pressure, or severe osteoarthritis, it seems that using surgery solely to prevent these conditions may be outweighed by potential risks. That being said, a marked reduction in risk of developing type 2 diabetes is certainly an added bonus to the patient having bariatric surgery who is having bariatric surgery for other reasons.
Thanks to my friend Gord for the inspiration for this blog post!