Efficacy in type 2 diabetes mellitus remission in patients undergoing bariatric surgery

• Published in: Endocrinología, diabetes y nutrición. Vol. 66; no. 1; pp. 56 - 61
• Main Authors: Pereyra-García Castro, Francisca María, Oliva García, José Gregorio, García Nuñez, María Araceli, García Bray, Bruno Francisco, Suarez Llanos, José Pablo, Moneva Arce, Modesto Enrique, Palacio Abizanda, José Enrique
• Format: Journal Article
• Language: English
• Published: Elsevier España, S.L.U 01-01-2019
• Subjects: Bariatric surgery; Cirugía bariátrica; Cirugía metabólica; Diabetes mellitus tipo 2; Endocrinology and Metabolism; Metabolic surgery; Remisión diabetes mellitus tipo 2; Type 2 diabetes mellitus; Type 2 diabetes mellitus remission; Cirugía metabólica; Metabolic surgery; Cirugía bariátrica; Bariatric surgery; Diabetes mellitus tipo 2; Type 2 diabetes mellitus remission; Remisión diabetes mellitus tipo 2; Type 2 diabetes mellitus
• ISSN: 2530-0180; 2530-0180
• DOI: 10.1016/j.endien.2018.08.003

Abstract Objectives To assess remission of type 2 diabetes mellitus (T2DM) after bariatric surgery, to analyze potential conditioning factors, and to compare Spanish and American remission criteria. Material and methods A retrospective study of diabetic patients undergoing Roux-en-Y gastric bypass from 2009 to 2015. Data collected included age, sex, time since T2DM diagnosis, antidiabetic drugs, insulin (type and dose), weight and BMI, percent excess weight lost, HbA1c , blood glucose levels, and course of T2DM after surgery according to Spanish and American criteria, including a descriptive analysis and correlation between both. Results The study sample consisted of 106 patients. Outcomes one year after surgery was as follows (Spanish criteria): complete remission 65.9%, partial remission 5.5%, improvement 18.9%, no change 9.7% (at 5 years: 68.4, 5.3, 10.5, and 15.8%, respectively). Outcomes according to ADA criteria were as follows: complete remission 61.5%, partial remission 5.3%, and no remission 28.6% (after 5 years, complete remission 68.4%). There was a good correlation between both classifications (rho = 0.974; p < 0.001). Mean HbA1c levels: 7.3 ± 1.8% at baseline; 5.7 ± 1% at one year; 6.3 ± 1.2% at 5 years. Chance of remission was lower in patients aged over 50 years (54.4% vs. 88.2%; p = 0.001), with T2DM diagnosed more than 10 years before (26.3% vs. 81.8%; p < 0.001), on insulin treatment (31.3% vs. 87.9%; p < 0.001), and with HbA1c levels ≥8% (40% vs. 77%; p = 0.001). Conclusions At our hospital, bariatric surgery is associated to a high remission rate of T2DM in patients with morbid obesity, with a good correlation between Spanish and American criteria. Age over 50 years old, long T2DM duration, poorer baseline metabolic control, and previous insulin treatment are markers of poorer response.