In many obese diabetic patients, one of the most dreaded complications of Type 2 diabetes can be put into remission or prevented entirely with bariatric surgery, according to a new study from the Cleveland Clinic presented here at the 29th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).
The study found that nearly 60 percent of obese patients with diabetic nephropathy, the leading cause of end-stage kidney disease, no longer had the condition five years after surgery. Additionally, only 25 percent of obese diabetics without nephropathy at the time of surgery eventually developed this complication. Researchers noted this incidence rate after surgery is about 50 percent less than what occurs in the non-surgically treated diabetes population. The five-year remission and improvement rates for Type 2 diabetes were 44 percent and 33 percent, respectively.
"When we started this study, we thought bariatric surgery may just halt the progression of diabetic nephropathy, instead over half of the patients who had diabetic nephropathy prior to undergoing bariatric surgery experienced remission. This is a remarkable finding that warrants greater consideration of bariatric surgery in this patient population," said lead study author Helen M. Heneghan, MD, a bariatric surgery fellow at the Cleveland Clinic Bariatric and Metabolic Institute in Ohio.
About seven million Americans have diabetic kidney disease, which jumped 34 percent in the last two decades, despite a substantial increase in the use of medications to treat the disease. Diabetes is the most common cause of kidney disease, a condition that independently increases the risk of heart disease and death.
The study included 52 patients, mostly female, who suffered from obesity and Type 2 diabetes for almost nine years. They had an average body mass index (BMI) of 49 before undergoing bariatric surgery, which was primarily gastric bypass surgery. Nearly 40 percent had diabetic nephropathy prior to undergoing surgery, a complication of diabetes caused by uncontrolled blood sugar which, in severe cases, can require dialysis or lead to kidney failure. In the United States, diabetic nephropathy accounts for about 40 percent of new cases of end-stage renal disease.
"No medical therapy has been as effective in achieving an effect of this magnitude on diabetic nephropathy," said study co-author Philip R. Schauer, MD, professor of surgery and director of the Cleveland Clinic Bariatric and Metabolic Institute. Dr. Schauer published a study earlier this year in the New England Journal of Medicine that showed bariatric surgery can put Type 2 diabetes into remission even before substantial weight loss occurs. In addition to remission or improvement of Type 2 diabetes and its complications in the current study, patients were able to maintain 50 percent excess weight loss after five years, and also achieved significant improvements in blood pressure and cholesterol levels.
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