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Downgrading of Type 2 Diabetes Mellitus (T2DM) after Obesity Surgery: Duration and Severity Matter

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Abstract

Background

There is overwhelming evidence for the antidiabetic effect of obesity surgery, but few reports involve objective longitudinal measurements of severity of type-2 diabetes mellitus (T2DM). This study applies a grading scheme and analyses the prognostic impact of routine clinical factors.

Material and Methods

This retrospective study includes 77 obese diabetic patients with a preoperative BMI of 48.9 ± 7.8 kg/m2 who underwent gastric banding (n = 4), Roux-en-Y gastric bypass (n = 57), or sleeve gastrectomy (n = 16) between 2007 and 2013. A 6-point scoring system graded the level of antidiabetic therapy. Downgrading was calculated from the difference between pre- and postoperative grades.

Results

Downgrading reached its maximum at 3 months well before maximal weight loss: one grade in 6 (8 %) patients, two grades in 36 (47 %) patients, and three or more grades in 20 (26 %) patients. Age, gender, and preoperative weight had no impact on downgrading. There were no significant differences between gastric banding (median 1; 0–2), gastric bypass (median 2; 0–5), and sleeve gastrectomy (median 2; 0–4). Preoperative duration of T2DM and its severity grade were independent prognostic factors in multivariate analysis. The rate of patients who could discontinue insulin was more than 80 % when the duration of preexisting T2DM was less than 5 years as compared to 62 % when the duration was more than 5 years.

Conclusion

The severity of T2DM downgrades in most patients within the initial period of postoperative weight loss. Downgrading increases with shorter duration and lower severity grade of pre-existing T2DM.

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Acknowledgments

The authors thank Dr Philip Sedgwick BSc, PhD, FSS, Reader in Medical Statistics and Medical Education, Institute of Medical and Biomedical Education, St. George’s, University of London, for his statistical assistance.

Conflict of Interest Statement

The authors have no conflict of interest to declare.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

For this type of study formal consent is not required.

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Authors and Affiliations

  1. St George’s Hospital Medical School, University of London, Cranmer Terrace, London, SW17 0RE, UK

    Mira Runkel

  2. Department of General Surgery, Schwarzwald-Baar Klinikum, Teaching Hospital University of Freiburg, Klinikstrasse 1, 78052, Villingen-Schwenningen, Germany

    Silke Müller, Rayner Brydniak & Norbert Runkel

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  1. Mira Runkel
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Correspondence to Norbert Runkel.

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Runkel, M., Müller, S., Brydniak, R. et al. Downgrading of Type 2 Diabetes Mellitus (T2DM) after Obesity Surgery: Duration and Severity Matter. OBES SURG 25, 494–499 (2015). https://doi.org/10.1007/s11695-014-1419-3

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