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Ethnicity Does Not Influence Glycemic Outcomes or Diabetes Remission After Sleeve Gastrectomy or Gastric Bypass in a Multiethnic Asian Cohort

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Abstract

Background

In Asia, metabolic-bariatric surgery (MBS) rates have grown rapidly in parallel with rising prevalence of obesity and type 2 diabetes (T2D).

Objective

The objective of this study was to identify factors that influence glycemic outcomes and diabetes remission 12 months after sleeve gastrectomy (SG) or gastric bypass (GB) in a multiethnic Asian cohort.

Setting

The study’s setting was in a tertiary hospital in Singapore.

Methods

Data from 145 T2D patients who had SG (37%) or GB (63%) and at least 1-year follow-up were analyzed. Diabetes remission was defined as hemoglobin A1c ≤ 6.0% without diabetes medications. Analysis involved binary logistic regression to identify predictors and general linear regression for variables associated with glycemic improvement after surgery.

Results

Baseline parameters are as follows: BMI 40.0 ± 7.6 kg/m2, A1c 8.4 ± 1.6%, diabetes duration 9.3 years, ethnic composition: Chinese (51.7%), Malay (23.4%), Indian (20.7%), Others (4.1%). 55.9% achieved diabetes remission at 1 year. Baseline A1c, baseline BMI, and diabetes duration were significant pre-operative factors for remission (cumulative R 2 = 0.334). At 12 months, percentage weight loss was similar after SG (24.1 ± 7.4%) and GB (25.4 ± 7.4%, p = 0.31). Greater A1c decrease was seen with GB compared to SG (2.7 ± 1.6 vs 2.0 ± 1.5%, p = 0.006), significant even after adjustment for weight loss, age, BMI, baseline A1c, and diabetes duration (p = 0.033). Weight loss at 12 months also correlated independently with A1c reduction. Ethnicity did not influence weight loss, diabetes remission, or glycemic control after MBS.

Conclusion

Baseline A1c, baseline BMI, and diabetes duration independently predict diabetes remission after MBS. GB is more effective in controlling T2D compared to SG despite similar weight loss, whereas ethnicity does not play a significant role in the multiethnic Asian cohort.

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Acknowledgements

We would like to thank Vieon Wu Aini for data collection and maintenance of the database and Drs Shanker Pasupathy, Alvin Eng, Chan Weng Hoong and Eugene Lim who performed the surgeries and cared for the patients.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore

    Phong Ching Lee, Kwang Wei Tham, Sonali Ganguly & Hong Chang Tan

  2. Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore

    Alvin Kim Hock Eng

  3. Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Australia

    John B. Dixon

Authors
  1. Phong Ching Lee
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  2. Kwang Wei Tham
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  3. Sonali Ganguly
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  4. Hong Chang Tan
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  5. Alvin Kim Hock Eng
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  6. John B. Dixon
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Corresponding author

Correspondence to Phong Ching Lee.

Ethics declarations

The study was approved by the Singhealth Institutional Review Board.

Conflict of Interest

Sonali Ganguly and Alvin Eng serve on medical advisory board for Novo Nordisk. John Dixon has provided consultancy services to Allergan Medical, Apollo Endosurgery, Bariatric Advantage, Covidien, Nestle Health Science, iNova Pharmaceuticals, and Novo Nordisk. Phong Ching Lee, Kwang Wei Tham, and Hong Chang Tan have no relevant disclosures.

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For this type of study, formal consent from patients is not required.

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Lee, P.C., Tham, K.W., Ganguly, S. et al. Ethnicity Does Not Influence Glycemic Outcomes or Diabetes Remission After Sleeve Gastrectomy or Gastric Bypass in a Multiethnic Asian Cohort. OBES SURG 28, 1511–1518 (2018). https://doi.org/10.1007/s11695-017-3050-6

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  • DOI: https://doi.org/10.1007/s11695-017-3050-6

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