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

• Published in: Endocrinologia, diabetes y nutricion 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; Spanish
• Published: Spain 01-01-2019
• Subjects: Bariatric Surgery; Diabetes Complications - complications; Diabetes Complications - surgery; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - surgery; Female; Humans; Male; Middle Aged; Obesity, Morbid - complications; Obesity, Morbid - surgery; Remission Induction; Retrospective Studies; Treatment Outcome; Cirugía metabólica; Cirugía bariátrica; Metabolic surgery; Bariatric surgery; Diabetes mellitus tipo 2; Type 2 diabetes mellitus remission; Remisión diabetes mellitus tipo 2; Type 2 diabetes mellitus
• ISSN: 2530-0172; 2530-0180
• DOI: 10.1016/j.endinu.2018.08.007

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.
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, HbA
, blood glucose levels, and course of T2DM after surgery according to Spanish and American criteria, including a descriptive analysis and correlation between both.
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<.001). Mean HbA
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=.001), with T2DM diagnosed more than 10 years before (26.3 vs. 81.8%; P<.001), on insulin treatment (31.3 vs. 87.9%; P<.001), and with HbA
levels≥8% (40 vs. 77%; P=.001).
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.