Skip to main content
SpringerLink
Log in

Impact of Different Criteria on Type 2 Diabetes Remission Rate After Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) achieve similar type 2 diabetes mellitus (T2DM) remission rates. Since a great variability exists in defining T2DM remission, an expert panel proposed partial and complete remission criteria that include the maintenance of fasting plasma glucose (FPG) and glycosylated hemoglobin (A1c) objectives for at least 1 year. The 2-year T2DM remission rate and time needed to reach it after LSG or LRYGB were compared using different remission criteria.

Methods

This was a prospective cohort study of 55 T2DM subjects operated on with LSG (n = 21) or LRYGB (n = 34). Four models for defining remission were used: Buchwald criteria (FPG <100 mg/dl or A1c <6 %), American Diabetes Association (ADA) complete (FPG <100 mg/dl plus A1c <6 % maintained for at least 1 year), ADA partial (FPG <125 mg/dl with A1c <6.5 % maintained for at least 1 year), and ADA complete without time requirement.

Results

Both groups were comparable, except for higher A1c levels in the LSG group. The remission rate ranged from 43.6 % using ADA complete remission to 92.7 % with Buchwald criteria, with no differences between surgical procedures. Differences were found in the time to achieve remission only when ADA complete remission criteria (5.1 ± 2.9 months LRYGB and 9.0 ± 3.8 months LSG, p = 0.014) and ADA without time requirement criteria (4.9 ± 2.7 months LRYGB and 8.4 ± 3.9 months LSG, p = 0.005) were used.

Conclusions

T2DM remission rate varies widely depending on the criteria used for its definition. Remission occurred sooner after LRYGB when the strictest criteria to define remission were used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Whiting DR, Guariguata L, Weil C, et al. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res ClinPract. 2011;94(3):311–21.

    Article  Google Scholar 

  2. Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11.

    Article  PubMed  Google Scholar 

  3. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  PubMed  CAS  Google Scholar 

  4. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54.

    Article  PubMed  CAS  Google Scholar 

  6. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2012;35 Suppl 1:S11–63.

    Google Scholar 

  7. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  PubMed  Google Scholar 

  8. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  PubMed  CAS  Google Scholar 

  9. Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24(5):1005–10.

    Article  PubMed  CAS  Google Scholar 

  10. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Blackstone R, Bunt JC, Cortés MC, et al. Type 2 diabetes after gastric bypass: remission in five models using HbA1c, fasting blood glucose, and medication status. Surg Obes Relat Dis. 2012;8(5):548–55.

    Article  PubMed  Google Scholar 

  12. Pournaras DJ, Aasheim ET, Søvik TT, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2012;99(1):100–3.

    Article  PubMed  CAS  Google Scholar 

  13. Ramos-Levi AM, Cabrerizo L, Matía P, et al. Which criteria should be used to define type 2 diabetes remission after bariatric surgery? BMC Surg. 2013;13:8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.

    Article  PubMed  Google Scholar 

  15. Hubbard VS, Hall WH. National Institutes of Health Consensus Development Conference draft statement on gastrointestinal surgery for severe obesity. Obes Surg. 1991;1(3):257–65.

    Article  PubMed  Google Scholar 

  16. Genuth S, Alberti KG, Bennett P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26(11):3160–7.

    Article  PubMed  Google Scholar 

  17. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.

    Article  PubMed  CAS  Google Scholar 

  18. Ramos-Levi AM, Sanchez-Pernaute A, Cabrerizo L, et al. Remission of type 2 diabetes mellitus should not be foremost goal after bariatric surgery. Obes Surg. 2013;23(12):2020–5.

    Article  PubMed  Google Scholar 

  19. Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.

    Article  PubMed  CAS  Google Scholar 

  20. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.

    Article  Google Scholar 

  21. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405–12.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Zhang X, Gregg EW, Williamson DF, et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care. 2010;33(7):1665–73.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  23. Selvin E, Steffes MW, Zhu H, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010;362(9):800–11.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  24. Ackermann RT, Cheng YJ, Williamson DF, et al. Identifying adults at high risk for diabetes and cardiovascular disease using hemoglobin A1c National Health and Nutrition Examination Survey 2005–2006. Am J Prev Med. 2011;40(1):11–7.

    Article  PubMed  Google Scholar 

  25. Steele AM, Shields BM, Wensley KJ, et al. Prevalence of vascular complications among patients with glucokinase mutations and prolonged, mild hyperglycemia. JAMA. 2014;311(3):279–86.

    Article  PubMed  CAS  Google Scholar 

  26. Dixon JB, Chuang LM, Chong K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Hamza N, Abbas MH, Darwish A, et al. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis. 2011;7(6):691–6.

    Article  PubMed  Google Scholar 

  28. Lee WJ, Chong K, Chen JC, et al. Predictors of diabetes remission after bariatric surgery in Asia. Asian J Surg. 2012;35(2):67–73.

    Article  PubMed  Google Scholar 

  29. Jiménez A, Casamitjana R, Flores L, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256:1023–9.

    Article  PubMed  Google Scholar 

  30. Vidal P, Ramón JM, Goday A, et al. Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity. Mid-term results. Obes Surg. 2012;23:292–9.

    Article  Google Scholar 

  31. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21:1650–6.

    Article  PubMed  Google Scholar 

  32. Yang X, Yang G, Wang W, et al. A meta-analysis: to compare the clinical results between gastric bypass and sleeve gastrectomy for the obese patients. Obes Surg. 2013;23:1001–10.

    Article  PubMed  Google Scholar 

  33. Peterli R, Wölnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250(2):234–41.

    Article  PubMed  Google Scholar 

  34. Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.

    Article  PubMed  Google Scholar 

  35. Ramón JM, Salvans S, Crous X, et al. Effect of Roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial. J Gastrointest Surg. 2012;16(6):1116–22.

    Article  PubMed  Google Scholar 

  36. Tschöp M, Smiley DL, Heiman ML. Ghrelin induces adiposity in rodents. Nature. 2000;407(6806):908–13.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain

    A. Mas-Lorenzo, D. Benaiges, J. A. Flores-Le-Roux, J. Pedro-Botet, A. Parri, M. Villatoro, J. Chillarón & A. Goday

  2. Universitat Autònoma de Barcelona, Barcelona, Spain

    D. Benaiges, J. A. Flores-Le-Roux, J. Pedro-Botet, J. Chillarón, M. Pera, L. Grande & A. Goday

  3. Unit of Gastrointestinal Surgery, Hospital del Mar, Barcelona, Spain

    J. M. Ramon, M. Pera & L. Grande

  4. CIBEROBN, Madrid, Spain

    A. Goday

  5. Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain

    D. Benaiges, J. A. Flores-Le-Roux, J. Chillarón & A. Goday

Authors
  1. A. Mas-Lorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Benaiges
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. A. Flores-Le-Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Pedro-Botet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. M. Ramon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Parri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Villatoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Chillarón
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Pera
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. L. Grande
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. Goday
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

On Behalf of the Obemar Group

Corresponding author

Correspondence to D. Benaiges.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mas-Lorenzo, A., Benaiges, D., Flores-Le-Roux, J.A. et al. Impact of Different Criteria on Type 2 Diabetes Remission Rate After Bariatric Surgery. OBES SURG 24, 1881–1887 (2014). https://doi.org/10.1007/s11695-014-1282-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-014-1282-2

Keywords

Search

Navigation