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Comparative Characteristics of Patients with Type 2 Diabetes Mellitus Treated by Bariatric Surgery Versus Medical Treatment: a Multicentre Analysis of 277,862 Patients from the German/Austrian DPV Database

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Abstract

Introduction

Bariatric surgery is a well-established treatment option for serious obesity and concomitant type 2 diabetes mellitus (T2DM). In this analysis, we investigated predictors for bariatric surgery in everyday clinical practice.

Materials and Methods

In the DPV-registry, patients with T2DM from Germany and Austria treated by bariatric surgery were compared to non-surgery controls by descriptive statistics and regression analysis.

Results

Among 277,862 patients with T2DM, 0.07% underwent bariatric surgery. Surgery patients were predominantly female [61.20%], younger [median age (Q1;Q3) 54.74(47.40;61.61) vs. 70.04 (60.36;77.58) years] and had a longer diabetes duration [11.21 (7.15;17.93) vs. 8.36 (2.94;14.91) years]. They had a higher BMI [40.02 vs. 30.61 kg/m2, adjusted p < 0.0001] and a slightly lower HbA1c [7.25 vs. 7.56%, adjusted p < 0.05]. There was a trend using more often insulin therapy (52.79 vs.50.08%, n.s.) with no difference in insulin dose/kg × day [0.56 vs. 0.58, n.s.]. Sleeve gastrectomy was performed most frequently, followed by Roux-en-Y gastric bypass, gastric banding, gastric balloon and others. A 2-year follow-up data in 29 patients demonstrated significant reductions in BMI [45.23 to 38.00 kg/m2, p < 0.005] and HbA1c [7.98 to 6.98%, p < 0.005], and a trend for reduced insulin requirements [62.07 vs. 44.83%, n.s.].

Conclusion

Despite favourable 2-year outcomes, bariatric surgery is still used rarely in patients with T2DM and obesity. BMI rather than metabolic control seems to represent the major selector for or against bariatric surgery in T2DM.

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Acknowledgements

We acknowledge the participating diabetes centres in Germany and Austria listed in alphabetical order:

Aachen - Innere RWTH, Aidlingen Praxisgemeinschaft, Altötting-Burghausen Innere Medizin, Asbach Kamillus-Klinik Innere, Augsburg Innere, Zentralklinikum, Bad Aibling Internist. Praxis, Bad Driburg/Bad Hermannsborn Innere, Bad Hersfeld Innere, Bad Kreuznach-St.Marienwörth-Innere, Bad Kreuznach-Viktoriastift, Bad Krozingen Klinik Lazariterhof Park-Klinikum, Bad Lauterberg Diabeteszentrum Innere, Bad Mergentheim - Diabetesfachklinik, Bad Mergentheim - Gemeinschaftspraxis DM-dorf Althausen, Bad Oeynhausen Herz-und Diabeteszentrum NRW, Bad Orb Spessart Klinik Reha, Bad Reichenhall Kreisklinik Innere Med., Bad Säckingen Hochrheinklinik Innere, Bautzen Oberlausitz KK, Bayreuth Innere Medizin, Berchtesgaden CJD, Berchtesgaden MVZ Innere Med, Berlin DRK-Kliniken, Berlin Endokrinologikum, Berlin Evang. Krankenhaus Königin Elisabeth, Berlin Klinik St. Hedwig Innere, Berlin Oskar Zieten Krankenhaus Innere, Berlin Parkklinik Weissensee, Berlin Schlosspark-Klinik Innere, Berlin St. Josephskrankenhaus Innere, Berlin Vivantes Hellersdorf Innere, Bottrop Knappschaftskrankenhaus Innere, Braunfels-Wetzlar Innere, Bremen - Mitte Innere, Castrop-Rauxel Rochus-Hospital, Chemnitz-Hartmannsdorf Innere Medizin - DIAKOMED-1, Coesfeld/Dülmen Innere Med., Darmstadt Innere Medizin, Deggendorf Medizinische Klinik II, Dortmund Knappschaftskrankenhaus Innere, Dortmund Medizinische Kliniken Nord, Dortmund-Hombruch Marienhospital, Dortmund-St. Josefshospital Innere, Dortmund-West Innere, Duisburg Evang. und Johanniter Krhs Innere, Duisburg Malteser Rhein-Ruhr St. Anna Innere, Duisburg Malteser St. Johannes, Duisburg-Huckingen, Duisburg-Huckingen Malteser Rhein-Ruhr ST. Johannes, Duisburg-St.Johannes Helios, Eberswalde Klinikum Barnim Werner Forßmann - Innere, Eisleben Lutherstadt Helios-Klinik, Erlangen Uni Innere Medizin, Essen Diabetes-Schwerpunktpraxis, Eutin St.-Elisabeth Innere, Forchheim Diabeteszentrum SPP, Frankfurt Diabeteszentrum Rhein-Main-Erwachsenendiabetologie (Bürgerhospital), Frankfurt Uni-Klinik Innere, Freiburg Uni Innere, Friedberg Innere Klinik, Fulda Innere Medizin, Gaissach Fachklinik der Deutschen Rentenversicherung Bayern Süd, Geislingen Klinik Helfenstein Innere, Gelnhausen Innere, Gießen Ev. Krankenhaus Mittelhessen, Göppingen Innere Medizin, Güstrow Innere, Halberstadt Innere Med. St. Salvator AMEOS Klinik, Hamburg Endokrinologikum, Hanau St. Vincenz - Innere, Hannover Henriettenstift - Innere, Heidelberg St. Josefskrankenhaus, Heidelberg Uniklinik Innere, Heidenheim Arztpraxis Allgemeinmed, Heilbronn Innere Klinik, Herford Innere Med I, Heringsdorf Inselklinik, Herne Evan. Krankenhaus Innere, Herten St. Elisabeth Innere Medizin, Herzberg Kreiskrankenhaus Innere, Hildesheim GmbH - Innere, Idar Oberstein Innere, Ingolstadt Klinikum Innere, Innsbruck Universitätsklinik Innere, Iserlohn Innere Medizin, Kamen Klinikum Westfalen Hellmig Krankenhaus, Karlsburg Klinik für Diabetes & Stoffwechsel, Kassel Rot-Kreuz-Krankenhaus Innere, Kaufbeuren Innere Medizin, Kempen Heilig Geist - Innere, Kempen Heilig Geist-KHS - Innere, Kirchheim-Nürtingen Innere, Kleve Innere Medizin, Koblenz Kemperhof 1. Med. Klinik, Konstanz Innere Klinik, Krefeld Alexianer Innere, Krefeld Innere Klinik, Krefeld-Uerdingen St. Josef Innere, Kreischa-Zscheckwitz Klinik Bavaria, Landau/Annweiler Innere, Lilienthal Diabeteszentrum, Limburg Innere Medizin, Lindenfels Luisenkrankenhaus Innere, Lindenfels Luisenkrankenhaus Innere 2, Linz AKH - 2. Med, Linz Krankenhaus Barmherzige Schwestern Kardiologie Abt. Int. II, Ludwigsburg Innere Medizin, Ludwigshafen diabetol. SPP, Lübeck Uni-Klinik Innere Medizin, Lünen Klinik am Park, Magdeburg Städtisches Klinikum Innere, Mannheim Uniklinik Innere Medizin, Marburg - UKGM Endokrinologie & Diabetes, Marktredwitz Innere Medizin, Marpingen-SPP, Moers - St. Josefskrankenhaus Innere, Murnau am Staffelsee - diabetol. SPP, Mölln Reha-Klinik Hellbachtal, Mühlacker Enzkreiskliniken Innere, München Diabetes-Zentrum Süd, München Schwerpunktpraxis, Münster Clemens-Hospital Innere, Münster Herz Jesu Innere, Nagold Kreiskrankenhaus Innere, Neumarkt Innere, Neunkirchen Innere Medizin, Neuwied Marienhaus Klinikum St. Elisabeth Innere, Nidda Bad Salzhausen Klinik Rabenstein/Innere-1 Reha, Nidda Bad Salzhausen Klinik Rabenstein/Innere-2 Reha, Oberhausen Innere, Offenbach/Main Innere Medizin, Oldenburg Schwerpunktpraxis, Oschersleben MEDIGREIF Bördekrankenhaus, Osterkappeln Innere, Ottobeuren Kreiskrankenhaus, Pfullendorf Innere Medizin, Pirmasens Städtisches Krankenhaus Innere, Plauen Vogtlandklinikum, Prenzlau Krankenhaus Innere, Rastatt Kreiskrankenhaus Innere, Recklinghausen Dialysezentrum Innere, Reutlingen Klinikum Steinenberg Innere, Rosenheim Innere Medizin, Rosenheim Schwerpunktpraxis, Rostock Universität Innere Medizin, Saaldorf-Surheim Diabetespraxis, Scheidegg Prinzregent Luitpold, Schwerin Innere Medizin, Schwäbisch Hall Diakonie Innere Medizin, Sinsheim Innere, Spaichingen Innere, Stuttgart Bethesda Agaplesion, Sylt Rehaklinik, Tettnang Innere Medizin, Timmendorfer Strand, Traunstein diabetol. Schwerpunktpraxis, Trostberg Innere, Ulm Endokrinologikum, Ulm Schwerpunktpraxis Bahnhofsplatz, Ulm Uni Innere Medizin, Villingen-Schwenningen SPP, Villingen-Schwenningen Schwarzwald-Baar-Klinikum Innere, Wangen Oberschwabenklinik Innere Medizin, Weisswasser Kreiskrankenhaus, Wernberg-Köblitz SPP, Wetzlar Schwerpunkt-Praxis, Wien 3. Med. Hietzing Innere, Wien Rudolfstiftung, Wien SMZ Ost Donauspital, Wien Uni Innere Med III, Wien Wilhelminenspital 5. Med. Abteilung, Wilhelmshaven St. Willehad Innere, Wittenberg Innere Medizin, Wolgast Innere Medizin, Zweibrücken Ev. KH. Innere.

Funding

This work was supported by Kompetenznetz Diabetes Mellitus (Competence Network for Diabetes Mellitus), funded by the Federal Ministry of Education and Research (FKZ 01GI1106), which was integrated into the German Center for Diabetes Research as of January 2015. In addition, the DPV initiative was supported by the European Foundation for the Study of Diabetes (EFSD), the EU-IMI2-initative, DIRECT and the German Diabetes Association (DDG).

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Authors and Affiliations

  1. Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Katharina Laubner & Jochen Seufert

  2. Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany

    Nicole Prinz, Esther Bollow & Reinhard W. Holl

  3. German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany

    Nicole Prinz, Esther Bollow & Reinhard W. Holl

  4. Clinic for Internal Medicine, Oberschwabenklinik Wangen, Wangen, Germany

    Joachim Brückel

  5. Clinic for Internal Medicine, Herz-Jesu-Krankenhaus Muenster-Hiltrup, Muenster, Germany

    Andreas Serwas

  6. Diabeteszentrum am Klinikum Dortmund, Dortmund, Germany

    Marcus Altmeier

  7. Clinic for Internal Medicine, Knappschaftskrankenhaus Bottrop, Bottrop, Germany

    Reinhard Welp

  8. Diabeteszentrum Forchheim, Forchheim, Germany

    Dietmar Krakow

  9. Diabetologische Schwerpunktpraxis, Murnau am Staffelsee, Germany

    Felix Groß

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  1. Katharina Laubner
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Disclosure

K. L. has nothing to disclose.

N. P. has nothing to disclose.

J. B. has nothing to disclose.

A. S. has nothing to disclose.

M. A. has nothing to disclose.

R. W. has nothing to disclose.

F.G. has nothing to disclose.

D. K. has nothing to disclose.

E.B. has nothing to disclose.

J. S. has nothing to disclose.

R.W.H. has nothing to disclose.

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Laubner, K., Prinz, N., Brückel, J. et al. Comparative Characteristics of Patients with Type 2 Diabetes Mellitus Treated by Bariatric Surgery Versus Medical Treatment: a Multicentre Analysis of 277,862 Patients from the German/Austrian DPV Database. OBES SURG 28, 3366–3373 (2018). https://doi.org/10.1007/s11695-018-3380-z

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