Advertisement

Obesity Surgery

, Volume 20, Issue 9, pp 1245–1250 | Cite as

Preoperative Factors Predicting Remission of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery for Obesity

  • Tom C. Hall
  • Mike G. C. Pellen
  • Peter C. Sedman
  • Prashant K. Jain
Clinical Research

Abstract

Background

Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. This bariatric procedure has also been noted to resolve hyperglycaemia in up to 70% of obese diabetics. We evaluated outcomes in diabetic patients undergoing RYGB in our institution, aiming to identify factors predicting diabetes remission.

Methods

One hundred ten type 2 diabetic (T2DM) patients undergoing RYGB were studied. Baseline demographics, diabetic status pre- and post-surgery and outcomes were evaluated. Outcomes were compared to a matched non-diabetic cohort.

Results

The mean age of the patients was 45 ± 11. The majority (70%; n = 77) were female and the mean baseline body mass index was 47 ± 7. Mean (±SD range) excess weight loss at 6, 12 and 24 months was 58.3 ± 26.4% (30.5−167%), 63.2 ± 17.2% (0−99.2%) and 84.1 ± 21.3% (16.5−121%), respectively. Diabetic medication was discontinued in 68.4% patients and reduced in a further 14.3%. Mean preoperative HbA1c was 7.1 ± 2.0 and mean postoperative HbA1c 5.48 ± 0.2. Patients with a baseline HbA1c >10 had a 50% rate of remission compared to 77.3% with an HbA1c of 6.5−7.9. The mean duration of T2DM preoperatively was 5.5 ± 7 years. A preoperative duration of T2DM greater than 10 years was shown to significantly reduce the chances of remission (p = 0.005).

Conclusions

RYGB for morbid obesity achieves significant weight reduction in diabetic patients with remission of pre-surgical hyperglycaemia in the majority. The study supports findings that a shorter duration and better control of diabetes prior to surgery corresponds to a higher rate of remission. It supports the argument for early surgical intervention in the morbidly obese diabetic patient.

Keywords

Bariatric surgery Morbid obesity Roux-en-Y gastric bypass Remission Type 2 diabetes Glycaemic control 

Notes

Conflict of interest disclosure

The authors declare that they have no conflict of interest. Results were presented at the EAES congress 2009 (oral) and IFSO 2009 (poster).

References

  1. 1.
    Diabetes UK. www.diabetes.org.uk
  2. 2.
    National Institute for Health. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486–97.CrossRefGoogle Scholar
  3. 3.
    Wild S.H, Byrne C.D. The global burden of the metabolic syndrome and its consequences for diabetes and cardiovascular disease. The Metabolic Syndrome. 2005:1–43Google Scholar
  4. 4.
    National Service Framework for Diabetes: Standards, 2002Google Scholar
  5. 5.
    Coronary Heart Disease statistics, Diabetes supplement, British Heart Foundation Statistics Database 2001Google Scholar
  6. 6.
    Williams R, Gillam S, Murphy M. The true costs of Type 2 diabetes in the UK. Findings from T2ARDIS and CODE-2 UK. GlaxoSmithKline Uxbridge, UK; 2002Google Scholar
  7. 7.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Rubino F, Marescaux J. Effect of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Whitson B, Leslie D, Kellogg T et al. Entero-endocrine changes after gastric bypass in diabetic and nondiabetic patients: a preliminary. Study J Surg Res. 141;1:31−39Google Scholar
  10. 10.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-anlysis. JAMA. 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  11. 11.
    Torquati A, Lufti R, Abumrad N, et al. Is Roux en Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients? J Gastrointest Surg. 2005;9(8):1112–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes. A randomised controlled trial. Diabetes Care. 2009;32:580–4.CrossRefPubMedGoogle Scholar
  13. 13.
    NICE 2002/041. www.nice.org.uk/guidance
  14. 14.
    Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? ADA consensus statement. Diabetes Care. 2009;32(11):2133–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Inzucchi SE. Oral antihyperglycaemic therapy for type 2 diabetes. JAMA. 2002;287:360–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Turner RC, Cull CA, Frighi V, et al. Glycaemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus. JAMA. 1999;281:2005–12.CrossRefPubMedGoogle Scholar
  17. 17.
    Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. Diab Care. 2008;31:173–5.CrossRefGoogle Scholar
  18. 18.
    Sjostrom C, Lissner L, Wedel H, et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes Res. 1999;7:477–84.PubMedGoogle Scholar
  19. 19.
    Sjostrom L, Narbro K, Sjostrom D, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;23(357):741–52.CrossRefGoogle Scholar
  20. 20.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefPubMedGoogle Scholar
  21. 21.
    Finkelstein EA, Brown DS. A cost benefit simulation model of coverage for bariatric surgery among full time employees. Am J Manag Care. 2005;11(10):641–6.PubMedGoogle Scholar
  22. 22.
    Cremieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14(9):589–96.PubMedGoogle Scholar
  23. 23.
    Ikramuddin S, Klingman D, Swan T, et al. Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetic patients. Am J Manag Care. 2009;15(9):607–15.PubMedGoogle Scholar
  24. 24.
    Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Rubino F, Moo TA, Rosen DJ, et al. Diabetes surgery: a new approach to an old disease. Diab Care. 2009;32(2):S368–72.CrossRefGoogle Scholar
  26. 26.
    Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic roux-en y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–85.PubMedGoogle Scholar
  27. 27.
    Wittgrove A, Grove G. Laparoscopic gastric bypass, Roux en Y 500 patients: techniques and results, with 3-60 month follow up. Obes Surg. 2000;10:233–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Parikh M, Ayoung-Chee P, Romanos E, et al. Comparison of rates of resolution of diabetes mellitus after gastric banding, gastric bypass and biliopancreatic diversion. J Am Coll Surg. 2007;205(5):631–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Dolan K, Bryant R, Fielding GA. Treating diabetes in the morbidly obese by laparoscopic gastric banding. Obes Surg. 2003;13(3):439–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Chikunguwo S, Dodson PW, Meador JG et al. Durable Resolution of Diabetes after Roux en-Y Gastric Bypass is Associated with Maintenance of Weight Loss. Abstracts: 2009 Plenary Session/ SOARD 5 (2009) S1-S23. PL-101Google Scholar
  31. 31.
    Shah SS, Todkar JS, Shah PS. Should Gastric Bypass Operation be Done for Type 2 Diabetes in Subjects with Body Mass Index 20-34 kgs/m2? An initial Indian experience. Abstracts: 2009 Plenary Session/ SOARD 5 (2009) S1-S23. PL-107Google Scholar
  32. 32.
    Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI >35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.CrossRefPubMedGoogle Scholar
  33. 33.
    Deurenberg P, Deaurenberg-Yap M, van Staveren WA. Body mass index and percent body fat: a meta-analysis among different ethnic groups. Int J Obes. 1998;22:1164–71.CrossRefGoogle Scholar
  34. 34.
    Jia WP, Lu JX, Xiang KS, et al. Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China. Obes Rev. 2002;3:157–65.CrossRefPubMedGoogle Scholar
  35. 35.
    Lee WJ, Wang W. Bariatric surgery: Asia-pacific perspective. Obes Surg. 2005;15:751–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Tom C. Hall
    • 1
  • Mike G. C. Pellen
    • 1
  • Peter C. Sedman
    • 1
  • Prashant K. Jain
    • 1
  1. 1.Department of Minimally Invasive and Upper Gastrointestinal SurgeryCastle Hill HospitalCottinghamUK

Personalised recommendations