Failed Surgical Weight Loss Does Not Necessarily Mean Failed Metabolic Effects

The metabolic profile of patients after a failed surgical weight loss procedure is unknown. Long-term clinical outcomes of 31 obese diabetes patients with post-bariatric surgery excess weight loss of <= 25% were assessed. At a median follow-up of 6 years (range, 5-9 years) after surgery, remission and clinical improvement of diabetes occurred in seven (23%) and 13 (42%) patients, respectively. A long-term mean total weight loss of 7.0 +/- 4.7% and excess weight loss of 13.7 +/- 8.5% were associated with a mean reduction in fasting blood glucose level, from 158.9 +/- 66.7 to 128.4 +/- 35.3 mg/dL (P=0.03), and a significant decrease in diabetes medication requirements (P<0.001). A significant decrease in systolic blood pressure (11.1 +/- 23.4 mm Hg, P=0.01) and level of circulating triglycerides (35.7 +/- 73.4 mg/dL, P=0.04) was also observed after surgery. A modest surgical weight loss in the range of 5-10% of initial weight was associated with significant improvement in cardiometabolic risk factors of morbidly obese diabetes patients. The markedly improved glycemic control (65% remission or clinical improvement) may be partly explained by weight-independent antidiabetes mechanisms of certain bariatric surgical procedures.