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New research finds that gastric bypass surgery can help people achieve long-term diabetes remission regardless of how much weight is lost. PIKSEL/Getty Images
  • New research finds that diabetes can remain in remission for years after gastric bypass surgery, regardless of how much weight a person loses.
  • However, key findings show that metabolic surgery patients were more likely to achieve full remission if several factors were in place.
  • These included if the patient had no insulin use prior to surgery, a lower HbA1c at baseline, and a lesser need for diabetes medications.

Weight loss is just one factor in whether or not someone reaches diabetes remission after gastric bypass surgery.

A new study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2023 Annual Scientific Meeting suggests gastric bypass surgery can lead to diabetes remission regardless of weight loss.

The study includes retrospective analysis of data from researchers from Mayo Clinic in Rochester, University of California San Francisco in Fresno, and Stony Brook University Medical Center in New York. The data was collected annually for 14 years on 815 people with diabetes and an average BMI of 45.1 who had gastric bypass surgery between 2008-2017.

Importantly, the researchers saw that while diabetes remission can occur long-term regardless of weight loss after gastric bypass surgery, they qualify this by saying diabetes remission rates were proportional to weight loss after surgery.

In other words, weight loss may not be the most important factor, but it still makes a difference in overall diabetes remission rates.

Key findings show that metabolic surgery patients were more likely to achieve full remission if there was:

  • no insulin use prior to surgery
  • a lesser need for diabetes medications
  • a shorter duration of the disease
  • a lower HbA1c at baseline
  • higher weight loss after surgery

Lead study author Dr. Omar Ghanem, a metabolic surgeon at Mayo Clinic in Rochester, MN says in a press release that the research takeaway is to maintain close monitoring and efficient management of diabetes after surgery: “Metabolic surgery is not a magic pill, but it offers perhaps the only chance for many people to rid themselves of diabetes and its associated complications once and for all.”

Dr. Mir Ali, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA tells Healthline this particular study reaffirms the many benefits of gastric bypass.

“The metabolic change induced by the gastric bypass shows lasting benefit in the treatment of diabetes based on this study,” says Ali.

Registered dietitian and diabetes rducator Julie Cunningham tells Healthline the evidence is clear that bariatric surgery helps people with type 2 diabetes improve their blood sugars, and in some cases it may actually help patients reverse diabetes.

“Patients who are in the earlier stages of type 2 diabetes — meaning they are not yet insulin-dependent, they’ve had diabetes for fewer years, or they have HbA1c levels at the lower end of the spectrum — have a greater chance of experiencing diabetes remission,” she says.

“So people living with diabetes who qualify for the surgery based on their body size may want to explore this option sooner rather than later if the potential for diabetes remission is one of their reasons for undergoing surgery,” says Cunningham.

The researchers suggest close monitoring of diabetes post-surgery, and experts agree.

“Managing diabetes after bariatric surgery requires close monitoring,” says Ali.

“Initially, the patient’s medications will need to be adjusted relatively quickly after surgery,” he tells Healthline. “Then, the patient is monitored closely to hopefully remain off medication or a greatly reduced dose.”

“If you live with diabetes and you have side effects from your medication, talk with your doctor or pharmacist about alternative options,” says Cunningham. “Stopping a medication without an alternative plan means you run the risk of high blood sugars, which may damage your eyes, kidneys, and other organs.”

Cunningham adds that you may find that you need to monitor less often as your blood sugar levels come down post-surgery, but says to always consult with your healthcare team before making this decision.

Go moderate- to low-carb

Kristin Kirkpatrick, MS, RDN, a nutritionist and the author of “Skinny Liver,” says low carbohydrate protocols help in the management of blood sugar and insulin.

“To maintain weight loss, and manage diabetes, a lower to moderate carbohydrate plan can be useful,” she says. “One way to follow such a plan is to increase fiber-rich foods in the diet that are naturally lower in carbohydrates such as non-starchy vegetables. Fiber may help to reduce digestible or net carbs in the diet,” Kirkpatrick tells Healthline.

Cunningham agrees, saying anyone with diabetes, whether they have had bariatric surgery or not, will benefit from managing their blood sugars by learning to count carbohydrates.

“Those who are not using insulin can consume a consistent amount of carbohydrate at each meal. This keeps blood sugar levels on an even keel,” she says.

“People who do use insulin can learn to use an insulin-to-carbohydrate ratio, which means that the amount of insulin injected varies according to the amount of carbs consumed on a meal-by-meal basis,” adds Cunningham.

If you’re not sure where to start, Cunningham says reaching out to a diabetes specialist is a good idea.

Focus on protein

Kirkpatrick points to a series of studies on protein that show that intake can help increase fullness and even minimize cravings throughout the day.

“Further, adequate protein can help maintain muscle mass through weight loss efforts after surgery,” she says. “In turn, weight loss may increase insulin sensitivity, which may help with the management of type 2 diabetes.”

Don’t skimp on sleep

“Inadequate sleep has been shown to be a risk factor for obesity as well as an increase in caloric intake,” says Kirkpatrick.

“To give yourself the best chance of taking weight off, and keeping it off, pay attention to your sleep health as an overall critical step towards better health,” she says.

Get some physical activity

“Regular exercise is important for blood sugar management,” says Cunningham. “When we exercise, our bodies use the sugar in our cells and our bloodstream as a source of fuel. This helps lower blood glucose levels in the short term, and it helps with weight management in the longer term.”

How much exercise should you aim for?

A minimum of 150 minutes of cardiovascular exercise per week is recommended, says Cunningham, “but those who were not exercising before surgery should get cleared by their physician first,” she adds.