Original Contributions

Obesity Surgery

, Volume 23, Issue 12, pp 2020-2025

Remission of Type 2 Diabetes Mellitus Should Not Be the Foremost Goal after Bariatric Surgery

  • Ana M. Ramos-LeviAffiliated withDepartment of Endocrinology and Nutrition, Facultad de Medicina, Complutense University
  • , Andres Sanchez-PernauteAffiliated withDepartment of Surgery, Facultad de Medicina, Complutense University
  • , Lucio CabrerizoAffiliated withDepartment of Endocrinology and Nutrition, Facultad de Medicina, Complutense University
  • , Pilar MatiaAffiliated withDepartment of Endocrinology and Nutrition, Facultad de Medicina, Complutense University
  • , Ana BarabashAffiliated withDepartment of Endocrinology and Nutrition, Facultad de Medicina, Complutense University
  • , Carmen HernandezAffiliated withDepartment of Surgery, Facultad de Medicina, Complutense University
  • , Alfonso L. Calle-PascualAffiliated withDepartment of Endocrinology and Nutrition, Facultad de Medicina, Complutense University
  • , Antonio J. TorresAffiliated withDepartment of Surgery, Facultad de Medicina, Complutense University
  • , Miguel A. RubioAffiliated withDepartment of Endocrinology and Nutrition, Facultad de Medicina, Complutense UniversityHospital Clinico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC), Facultad de Medicina, Complutense University Email author 

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Abstract

Background

Remission of type 2 diabetes (T2D) is a desired outcome after bariatric surgery (BS). Even if this goal is not achieved, individuals who do not strictly fulfill remission criteria experience an overall improvement. The aim of this study was to evaluate the metabolic control status in patients considered as diabetes “non-remitters.”

Methods

A retrospective study of 125 patients (59.2 % women) with preoperative diagnosis of T2D who underwent BS in a single center (2006–2011) was conducted. We collected anthropometric and metabolic parameters before surgery and at 1-year follow-up. T2D remission was defined according to the 2009 consensus statement: glycosylated hemoglobin (HbA1c) <6 %, fasting glucose (FG) <100 mg/dLs, and absence of pharmacologic treatment. We evaluated metabolic status of non-remitters, according to the American Diabetes Association's (ADA) target recommendations: HbA1c <7 %, LDL-c <100 mg/dL, triglycerides <150 mg/dL, and HDL-c >40 (male) or >50 mg/dL (female). Statistics: analysis of variance.

Results

Baseline characteristics (mean ± SD): age 53.5 ± 9.7 years, BMI 43.5 ± 5.6 kg/m2, time since diagnosis of T2D 7.7 ± 7.9 years, FG 162.0 ± 56.3 mg/dL, HbA1c 7.7 ± 1.6 %. ADA's target recommendations were present in 12 patients (9.6 %) preoperatively, and in 45 (36.0 %) at 1-year follow-up (p <0.001). Sixty-two (49.6 %) patients did not achieve diabetes remission; 26 (41.9 %) had now diet treatment, 30 (48.4 %) oral medications, and 6 (9.7 %) required insulin. Of the non-remitters, 57 (91.9 %) had HbA1c <7 % and 18 (40.0 %) achieved ADA's target recommendations. There were no differences between remitters and non-remitters in the number of individuals reaching ADA's combined metabolic control.

Conclusions

Although almost 50 % of the patients may not be classified as diabetes remitters, their significant improvement in metabolic control should be regarded as a success, according to most scientific societies' target recommendations.

Keywords

Diabetes Mellitus Type 2 Diabetes Remission Bariatric Surgery Remission Criteria Obesity Morbid Obesity Combined Metabolic Control ADA Recommendations