Patients noticed decline in glycated hemoglobin within the first six months of surgery.

Gastric bypass may be an effective treatment for type 2 diabetes in patients who are only mildly obese, researchers said here.

The vast majority of patients (88 percent) had remission of their diabetes, bringing their glycated hemoglobin (HbA1c) to 6.5 percent, even after coming off their anti-diabetic drugs, David Cummings, MD, of the University of Washington in Seattle, and colleagues reported online in Diabetes Care and during a session at the American Diabetes Association meeting here.

An additional 11 percent achieved an HbA1c below 7 percent while decreasing their use of oral diabetic drugs and withdrawal of insulin, they found.

Gastric bypass “is a safe, effective procedure to ameliorate type 2 diabetes and associated comorbidities,” they wrote, adding that their findings justify further trials to clarify whether bypass “should be broadened and might be viewed primarily as a ‘metabolic’ rather than ‘bariatric’ surgery.”

Severely obese patients are often rid of their type 2 diabetes when they have gastric bypass surgery. An NIH consensus statement, however, limits the use of bariatric surgery to patients with a body mass index (BMI) of at least 35 kg/m2 in addition to comorbidities, the researchers said.

But patients with a BMI between 30 and 35 kg/m2constitute the majority of obese patients, and many have diabetes. Thus, researchers have asked whether roux-en-Y gastric bypass should be offered to this population to treat type 2 diabetes.

They assessed 66 patients with a BMI of 30 to 35 kg/m2, all of whom had severe, long-standing diabetes, with a mean disease duration of 12.5 years and an HbA1c of 9.7 percent despite insulin or oral diabetes drugs.

All patients had roux-en-Y gastric bypass surgery and were followed for a median of 5 years.

The main outcomes included safety and the percentage of patients who had remission of their diabetes as measured by reaching an HbA1c of less than 6.5 percent without the use of medications.

Cummings and colleagues found that 88 percent of patients had remission of their diabetes, with an additional 11 percent having glycemic improvement, reaching an HbA1c below 7 percent with decreased use of oral diabetes drugs and withdrawal of insulin.

Overall, most changes occurred in the first 6 months, with the mean HbA1c falling from 9.7 percent to 5.9 percent even though the majority of patients stopped using diabetes medications, they reported.

Mean fasting plasma glucose also fell, from 156 mg/dL to 97 mg/dL.

Patients also generally had major reductions in waist circumference and total body weight, they found.

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