Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS bariatric surgery center of excellence program as reported in the Bariatric Outcomes Longitudinal Database
Abstract
In Brief Objective: Small case series suggest bariatric surgery may be an effective treatment for type 2 diabetes mellitus in patients who do not meet body weight criteria for morbid obesity (body mass index [BMI], <35 kg/m2), but large multi-institutional series, which allow better assessment of the safety and efficacy of treatment, have not been reported. Methods: Data from 66,264 research-consented patients with a primary bariatric surgery encounter in the Bariatric Outcomes Longitudinal Database from June 2007 to June 2009 were queried to identify patients with a BMI ≥30 but <35 kg/m2 (1.2%, n = 794) and diabetes requiring any medication (29%). Results: A total of 235 patients met inclusion criteria. The 2 most common procedures, adjustable gastric banding (n = 109) and gastric bypass (n = 109), were compared. Laparoscopic access was used in 92% of procedures. Gender (76.6% female), race (80.4% White), and age (mean 52.6 ± 10.4 years) did not differ between procedure groups. Gastric bypass provided superior weight loss and diabetes remission but demonstrated more frequent complications (90-day complications: 18% vs. 3%, P < 0.05). No mortalities were reported, and most complications were minor. Conclusions: The data suggest early effectiveness of surgical treatment of diabetes in patients who do not meet criteria for morbid obesity. Gastric bypass provides more effective treatment for diabetes than adjustable gastric banding within 6 to 12 months. Safety and efficacy of metabolic surgery for diabetes in 235 patients with a body mass index ≥30 but <35 kg/m2 from participants in the American Society for Metabolic and Bariatric Surgery of Excellence program as reported in Surgical Review Corporation's Bariatric Outcomes Longitudinal Database.
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Calcium malabsorption has been documented as early as 3 months after RYGB, with reduced true fractional calcium absorption and secondary hyperparathyroidism.
“Calcium malabsorption has been documented as early as 3 months after RYGB53, 54 with reduced true fractional absorption of calcium57, and secondary hyperparathyroidism52, 53, 58, 59.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
Bone turnover increases as early as 3 months after RYGB.
“Bone turnover increases as early as 3 months after RYGB 53, 54.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
The authors found stable 25OHD levels despite more than 200% increases in vitamin D intake after RYGB.
“We found stable 25 OHD levels despite more than 200% increases in vitamin D intake (mean of 658 IU/d at baseline, 1698 IU/d at 12 months)53”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
After RYGB, patients typically lose 35% of initial weight or 62-75% of excess body weight, significantly more than with gastric banding.
“After RYGB, patients typically lose 35% of initial weight, or 62-75% of excess body weight47, 52-54, significantly greater than with GB.55, 56.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
Hip BMD declines after RYGB range between 8% and 11%.
“Declines in hip BMD range between 8-11%17, 52-54, 62, 67-69.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
Spine BMD changes after RYGB are variable, with some studies reporting small decreases and others not.
“Changes at the spine are more variable, some studies report small decreases 24, 54, 63, 67-69, while others have not 52, 53, 65, 66.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
A strong association between extent of weight loss after bariatric surgery and amount of bone loss has been documented by most but not all studies.
“A strong association between extent of weight loss after bariatric surgery and amount of bone loss has been documented bymost40, 45, 51-53, 62, 67 but not all studies.63”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
After RYGB, declines at total hip (r=0.65, p=0.02) and femoral neck (r=0.90, p<0.0001) were associated with extent of weight loss.
“We found that after RYGB, declines at the TH (r=0.65, p=0.02) and FN (r=0.90, p<0.0001) were associated with the extent of weight loss (Figure 2)53.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
Increased PTH is associated with greater femoral neck bone loss and cortical bone loss at the tibia.
“PTH may affect hip bone loss as well; with increased PTH associated with greater bone loss at the FN53 and with cortical bone loss at the tibia 52 (Figure 3).”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [53]
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- Authors
- DeMaria, E. J., Winegar, D. A., Pate, V. W., Hutcher, N. E., Ponce, J., & Pories, W. J.
- Affiliations
- Duke University (US)
- East Carolina University (US)
- Corresponding author
- DeMaria, Eric J.
- Venue
- Annals of Surgery
- Published
- 2010-09
- Volume
- 252
- Issue
- 3
- Pages
- 559-567
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2066885372
- Cited by
- 137
- References
- 16
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 5 · 2017: 6 · 2016: 10 · 2015: 15 · 2014: 15 · 2013: 29 · 2012: 14
- FWCI
- 21.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American College of Surgeons
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- bariatric surgery, type 2 diabetes, metabolic surgery, gastric bypass, gastric banding, diabetes remission, weight loss, postoperative complications, body mass index
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Longitudinal Studies, Male, Middle Aged, Laparoscopy, Postoperative Complications, Body Mass Index, Chi-Square Distribution, Treatment Outcome, Bariatric Surgery
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