Best weight-loss surgery for diabetes and severe obesity?

Watch video on latest results from PCORnet Bariatric Study. (Spoiler alert: Bypass, not sleeve.)

Our large, long-term PCORnet Bariatric Study wanted to find out what kind of weight-loss surgery is best for people with diabetes and severe obesity. We just published our findings in JAMA Surgery: Comparing the Five-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass.

We studied nearly 10,000 diverse adults with diabetes at 34 centers in 11 networks of clinical information throughout the United States. We found that diabetes went away at some point over 5 years for most people in the study who had bariatric surgery.

“That's where they're off all medications, and that's where their blood sugar is normal,” says David Arterburn, MD, MPH. Dr. Arterburn is a senior investigator at Kaiser Permanente Washington Health Research Institute (KPWHRI) and an internal medicine physician at Washington Permanente Medical Group. He is the senior author of the new paper and a co-principal investigator of the PCORnet Bariatric Study.

Findings

• The rate of diabetes remission was slightly higher after gastric bypass than after sleeve gastrectomy.
• We saw much more control of blood sugar and lower body weight, for a longer time, after bypass than after sleeve.
• And diabetes was 25% less likely to come back within five years after bypass than after sleeve.

There's something about how bariatric surgery changes the digestive tract that helps type 2 diabetes to go away.

We hope our results will help people with diabetes, and their health care providers, make informed decisions about what kind of weight-loss surgery might be better for them.

“Every patient with diabetes and severe obesity should be having a conversation with their doctor about whether or not bariatric surgery is a reasonable treatment option for their diabetes,” Dr. Arterburn says.

The Patient-Centered Outcomes Research Institute (PCORI) Award OBS-1505-30683 funded our PCORnet Bariatric Study, part of PCORnet, the National Patient-Centered Clinical Research Network.

The paper is by these PCORnet Bariatric Study Collaborative authors:

• Kathleen McTigue, MD, and Anita Courcoulas, MD, University of Pittsburgh;
• David Arterburn, MD, MPH, R. Yates Coley, PhD, Andrea Cook, PhD, Robert Wellman, MS, Roy E. Pardee, JD, and Jane Anau, KPWHRI;
• Karen J. Coleman, PhD, Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena;
• Elizabeth Nauman, PhD, Louisiana Public Health Research Institute, New Orleans;
• Alberto Odor, MD, University of California, Davis;
• Julie Tice, MS, Penn State University, Hershey;
• Sengwee Toh, PhD, Jessica L. Sturtevant, MS, Casie Horgan, MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston;
• Cheri D. Janning, MS, Duke Clinical & Translational Science Institute, Durham; and
• Neely Williams, MDiv, Community co-Principal Investigator, STAR Clinical Research Network, & Community Partner, Meharry-Vanderbilt Alliance, Nashville.

KPWHRI video producer Melissa Parson, MFA, produced the video, with voiceover by KPWHRI research assistant John Ewing.