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Diabetes Remission and Relapse After Bariatric Surgery: a Nationwide Population-Based Study

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Abstract

Purpose

The long-term impact of bariatric surgery on the remission of type 2 diabetes (T2DM) remains to be clarified through large nationally representative cohorts. The objectives were to determine the incidence of T2DM remission and relapse after bariatric surgery, to determine the factors associated with remission and to establish a profile for patients at risk for relapse.

Materials and Methods

We conducted a population-based cohort study using data from the French national health insurance database (Systeme national des données de santé [SNDS]). We had access to exhaustive regional data between 2013 and 2017 and to a national representative sample of the French population (EGB) from 2008 to 2018. Patients were included if they were adults and diabetics with incidental bariatric surgery.

Results

This study shows that 50% of patients are in remission from diabetes after bariatric surgery within a median of 2 to 4 months. Diabetes relapse was observed in 13–20% within 10 years. The factors favouring remission already described were noted (non-insulin-dependent diabetes) and original factors were also identified, in particular the advantage of bypass surgery over sleeve gastrectomy, with more remissions and fewer relapses.

Conclusion

This study highlights a 50% prevalence of remission and a low prevalence of relapse. There are non-modifiable risk factors for remission and relapse (characteristics of diabetes, age, lipid-lowering therapy) and modifiable factors (type of surgery). Identifying these factors is essential for optimal management of patients. Additional data are essential to confirm the results of our analysis of the factors associated with relapse.

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References

  1. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273:219–34.

    Article  Google Scholar 

  2. Madsen LR, Baggesen LM, Richelsen B, et al. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study. Diabetologia. 2019;62:611–20.

    Article  Google Scholar 

  3. Panunzi S, De Gaetano A, Carnicelli A, et al. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis. Ann Surg. 2015;261:459–67.

    Article  Google Scholar 

  4. Zhou K, Wolski K, Malin SK, Aminian A, Schauer PR, Bhatt DL, et al. Impact of weight loss trajectory following randomization to bariatric surgery on long-term diabetes glycemic and cardiometabolic parameters. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2019.

  5. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39:861–77.

    Article  CAS  Google Scholar 

  6. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  Google Scholar 

  7. Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2010;6:254–9.

    Article  Google Scholar 

  8. DiGiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2010;6:249–53.

    Article  Google Scholar 

  9. Brethauer SA, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258:628–36. discussion 636-637

    Article  Google Scholar 

  10. Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23:93–102.

    Article  Google Scholar 

  11. Beleigoli AMR, Coelho ALB, Diniz MTC, et al. Outcomes in glycemic control in the intermediate follow-up of Roux-en-Y gastric bypass: a Brazilian cohort study. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10:1022–7.

    Article  Google Scholar 

  12. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet Lond Engl. 2015;386:964–73.

    Article  Google Scholar 

  13. Aminian A, Brethauer SA, Andalib A, et al. Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes. Ann Surg. 2016;264:674–81.

    Article  Google Scholar 

  14. Ghio B, Jiménez A, Corcelles R, et al. Midterm effects of bariatric surgery in patients with insulin-treated type 2 diabetes. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13:2004–9.

    Article  Google Scholar 

  15. Seki Y, Kasama K, Haruta H, et al. Five-year-results of laparoscopic sleeve gastrectomy with duodenojejunal bypass for weight loss and type 2 diabetes mellitus. Obes Surg. 2017;27:795–801.

    Article  Google Scholar 

  16. de Oliveira VLP, Martins GP, Mottin CC, et al. Predictors of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass in severely obese patients. Obes Surg. 2018;28:195–203.

    Article  Google Scholar 

  17. Debédat J, Sokolovska N, Coupaye M, et al. Long-term relapse of type 2 diabetes after Roux-en-Y gastric bypass: prediction and clinical relevance. Diabetes Care. 2018;41:2086–95.

    Article  Google Scholar 

  18. Czernichow S, Paita M, Nocca D, et al. Current challenges in providing bariatric surgery in France: a nationwide study. Medicine (Baltimore). 2016;95:e5314.

    Article  Google Scholar 

  19. Thereaux J, Lesuffleur T, Czernichow S, et al. Association between bariatric surgery and rates of continuation, discontinuation, or initiation of antidiabetes treatment 6 years later. JAMA Surg. 2018;153:526–33.

    Article  Google Scholar 

  20. Palmaro A, Moulis G, Despas F, et al. Overview of drug data within French health insurance databases and implications for pharmacoepidemiological studies. Fundam Clin Pharmacol. 2016;30:616–24.

    Article  CAS  Google Scholar 

  21. Moulis G, Lapeyre-Mestre M, Palmaro A, et al. French health insurance databases: what interest for medical research? Rev Med Interne. 2015;36:411–7.

    Article  CAS  Google Scholar 

  22. Bezin J, Duong M, Lassalle R, et al. The national healthcare system claims databases in France, SNIIRAM and EGB: powerful tools for pharmacoepidemiology. Pharmacoepidemiol Drug Saf. 2017;26:954–62.

    Article  Google Scholar 

  23. Conte C, Vaysse C, Bosco P, et al. The value of a health insurance database to conduct pharmacoepidemiological studies in oncology. Therapie. 2019;74:279–88.

    Article  Google Scholar 

  24. Fosse-Edorh S, Rigou A, Morin S, et al. Algorithms based on medico-administrative data in the field of endocrine, nutritional and metabolic diseases, especially diabetes. Rev Epidemiol Sante Publique. 2017;65(Suppl 4):S168–73.

    Article  Google Scholar 

  25. ameli.fr - Méthode. [cited 2019 May 7]. Available from: https://www.ameli.fr/l-assurance-maladie/statistiques-et-publications/etudes-en-sante-publique/cartographie-des-pathologies-et-des-depenses/methode.php.

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

    Article  Google Scholar 

  27. Borgeraas H, Hofsø D, Hertel JK, et al. Comparison of the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Obes Rev Off J Int Assoc Study Obes. 2020;21:e13011.

    Article  Google Scholar 

  28. Madadi F, Jawad R, Mousati I, et al. Remission of type 2 diabetes and sleeve gastrectomy in morbid obesity: a comparative systematic review and meta-analysis. Obes Surg. 2019;29:4066–76.

    Article  Google Scholar 

  29. Sharples AJ, Mahawar K. Systematic review and meta-analysis of randomised controlled trials comparing long-term outcomes of roux-en-Y gastric bypass and sleeve gastrectomy. Obes Surg. 2020;30:664–72.

    Article  Google Scholar 

  30. Le poids du diabète en France en 2016. Synthèse épidémiologique. / 2018 / Maladies chroniques et traumatismes / Rapports et synthèses / Publications et outils / Accueil [Internet]. [cited 2019 May 10]. Available from: http://invs.santepubliquefrance.fr/Publications-et-outils/Rapports-et-syntheses/Maladies-chroniques-et-traumatismes/2018/Le-poids-du-diabete-en-France-en-2016.-Synthese-epidemiologique.

  31. Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311:2297–304.

    Article  Google Scholar 

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Acknowledgements

The authors thank the Cardiomet Institute, Toulouse CHU, for their help and support.

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Authors and Affiliations

  1. Clinical Pharmacology Department, Toulouse University Hospital, Toulouse, France

    C. Conte & M. Lapeyre-Mestre

  2. Clinical Investigation Center (CIC 1436), INSERM and Toulouse University Hospital, Toulouse, France

    C. Conte & M. Lapeyre-Mestre

  3. Inserm unit 1027, University of Toulouse 3, Toulouse, France

    C. Conte, M. Lapeyre-Mestre & P. Ritz

  4. Diabetes Department, Toulouse CIO (Obesity Medicine Reference Center) and CHU (University Hospital), Toulouse, France

    H. Hanaire

  5. Nutrition Department, Toulouse CIO and CHU, Toulouse, France

    P. Ritz

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  1. C. Conte
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  2. M. Lapeyre-Mestre
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Correspondence to P. Ritz.

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Appendix

Appendix

Table 7 List of ICD-10 and CCAM codes used to identify obese patients with bariatric surgery by sleeve gastrectomy or by-pass surgery
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Conte, C., Lapeyre-Mestre, M., Hanaire, H. et al. Diabetes Remission and Relapse After Bariatric Surgery: a Nationwide Population-Based Study. OBES SURG 30, 4810–4820 (2020). https://doi.org/10.1007/s11695-020-04924-3

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  • DOI: https://doi.org/10.1007/s11695-020-04924-3

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