Earlier surgery may be better for early-onset type 2 diabetes

Research indicates that prompt surgical intervention may maximise the chances of patients with early-onset Type 2 diabetes attaining remission.

The study, published just after the endorsement of metabolic operation by multiple diabetes societies, reveals significantly greater weight loss and higher rates of Type 2 diabetes remission in patients diagnosed when younger than 40 years than in those that were older at diagnosis.

And there was a strong association between shorter duration of diabetes and likelihood of remission, especially among patients with early-onset diabetes, report Wei-Jei Lee (Min-Sheng General Hospital, Taoyuan City, Taiwan) and colleagues.

This is despite the two groups overall having a similar duration of diabetes, at 3.7 years in the 339 patients with early-onset diabetes and 3.8 years in the 219 patients with late-onset diabetes. Early-onset patients had significantly poorer glycaemic control at baseline, yet remission rates (glycated haemoglobin 6.0%) were 56.9% versus 50.2% after 1 year, and 65.3% versus 54.2% after 5 years.

However, this signals a substantial percentage of patients with persistent diabetes, which commentators David Harris and Ali Tavakkoli, from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, USA, describe as "an Achilles heel of bariatric surgery".

"So, identifying mark of long-term Type 2 symptoms of diabetes remission is, and will continue to be, an area of substantial curiosity about the subject", they write in JAMA Surgery