More than half of patients in the UAE with type 2 diabetes who undergo bariatric surgery achieve complete remission from their illness, according to a new study.
This rate of complete remission – typically defined as having low blood-sugar levels without medication – is around double that seen in trials with Western populations, the researchers behind the new study said.
While new drugs are transforming the treatment of obesity and diabetes, doctors say that bariatric surgery, which involves reducing the size of the stomach to cut the amount of food eaten, will still be needed for some patients, such as those for whom the medication is unsuitable.
Based on the outcomes for 238 patients who underwent bariatric surgery at Tawam Hospital in Al Ain, the research found a complete remission rate of 52.9 per cent, which compares to between 23 and 29 per cent seen in many studies in Western populations, the study indicated.
Five years after their bariatric surgery, 95.4 per cent of patients had discontinued all of their diabetes medication, with behavioural changes likely to be sufficient to control blood-glucose levels.
“This five-year analysis demonstrates that bariatric surgery produces transformative and sustained improvements in weight loss, glycaemic control and cardiometabolic health in Middle Eastern patients with type 2 diabetes,” the study authors wrote in Obesity Medicine.
With complication rates described as “low” and with the overwhelming majority of patients no longer requiring medication, the surgery is “a powerful intervention” for suitable patients, according to the authors.
The new study, “Impact of bariatric surgery on Type 2 Diabetes Mellitus: A comprehensive 5-year analysis of weight loss, glycaemic control and cardiometabolic outcomes,” is by researchers from UAE University in Al Ain and Tawam Hospital. The patients analysed had bariatric surgery between 2013 and 2019.
Five years on from surgery, patients had lost an average of 27.2 per cent of their body weight.
Critical fight against obesity
Obesity is a major risk factor for the development of type 2 diabetes, in which the body does not produce enough insulin or cells become resistant to the hormone. Conditions including cancer and heart disease are also more common in people with obesity.
The UAE has some of the highest obesity rates in the world, with about 30 per cent of women and 26 per cent of men in the UAE having the condition, figures from the Global Obesity Observer indicate. According to the study, 16.3 per cent of the UAE population has type 2 diabetes, one of the 15 highest rates in the world.
Richard Holt, professor of diabetes and endocrinology at the University of Southampton in the UK, said patients put forward for bariatric surgery in the UAE may be different to those who have the surgery in other countries, which could account for the better outcomes. “I can understand why the patterns of obesity may be different,” said Prof Holt, who was not connected to the UAE study.
“There may be populations where the drugs are more or less effective, and there may be issues relating to the behavioural changes that are possible, so therefore the characteristics of the individuals that go forward for surgery in the UAE may be slightly different compared with other centres in different parts of the world.
“There are challenges around lifestyle and health behaviour change that don’t necessarily apply in other parts of the world. For example, given the climate and the temperatures, it’s much more difficult to undertake physical activity in the Middle East than it is in a much more temperate climate.”
Weight-loss drugs to prompt surgery decline
Even though anti-obesity drugs have become highly successful at controlling obesity in some patients – common ones are Wegovy, Mounjaro and Ozempic – there is likely to continue to be a need for bariatric surgery, according to experts.
Prof Holt said studies suggested that around two in 10 obesity patients responded well to behavioural interventions and six or seven out of 10 to drugs, a proportion that is increasing as new medications come on stream.
However, he said that some patients experienced significant side effects with the drugs or did not find them to be effective, so there would still be people for whom bariatric surgery was suitable.
“I still think there’s a place for bariatric surgery, but it will become less common because there will be other alternatives to it,” he said. In some cases patients may, he said, have anti-obesity drugs before surgery, as doing so may improve the management of obesity after surgery.
Consider the long-term effects
Overall, he said, bariatric surgery was considered safe and typically caused more benefit than harm, although he added that aside from the risk of immediate complications, there was the potential for long-term side effects, including mineral or vitamin deficiencies.
“This is not an operation where you do it and then forget about it,” he said. “People who’ve had bariatric surgery will require long-term follow up.”
Dr Antje Hebestreit, of the Leibniz Institute for Prevention Research and Epidemiology in Bremen, Germany, said that while bariatric surgery did have side effects and risks, and was expensive, it could have transformative effects.
“I know three people who underwent this and they said it changed their lives,” she said. “For them it really worked out.” However, she said that it was far from ideal if large numbers of people either had bariatric surgery or took anti-obesity medication.
Instead, she said it was preferable for people to control their own weight by having a healthier diet and an active lifestyle, although this could be very difficult, not least because unhealthy foods are widely available and heavily advertised. Genetic factors also mean some people are more likely to become obese, Dr Hebestreit said. That can account for as much as 70 per cent of the risk.
“Even though they know their risk is higher and they would like to change their behaviour, it’s so difficult because the food environment is not helping them to make the right decisions,” she said.
“The food industry can produce healthy foods. The more pressure we put on the food industry … that should be the first thing we do before thinking about bariatric surgery for larger populations.”
