Obesity Surgery

, Volume 22, Issue 10, pp 1521–1526 | Cite as

Improvement of Type 2 Diabetes Mellitus (T2DM) After Bariatric Surgery—Who Fails in the Early Postoperative Course?

  • C. JurowichEmail author
  • A. Thalheimer
  • D. Hartmann
  • G. Bender
  • F. Seyfried
  • C. T. Germer
  • C. Wichelmann
Clinical Research



Diabetes surgery in nonobese or moderately obese patients is an emerging topic. The identification of preoperative factors predicting diabetes outcome following bariatric surgery, especially for metabolic nonresponders, is imperative.


Between 2005 and 2011, 235 patients underwent bariatric surgery for morbid obesity. Eighty-two of 235 patients had type 2 diabetes mellitus (T2DM). Data from this subgroup were investigated with univariate and multivariate analyses to identify predictors for metabolic nonresponse after surgery.


Diabetes did not improve in 17/82 patients within 3 months after surgery. No correlation between excess body weight loss and metabolic response was detected. In univariate analysis, preoperative duration of diabetes was significantly longer in the nonresponder group (9.146 vs. 6.270 years; *p = 0.016), preoperative HbA1c levels were significantly higher among the nonresponders than among the responders (8.341 vs. 7.781 %; *p = 0.033), and more patients in the nonresponder group were reliant on a multi-drug approach preoperatively (*p = 0.045). In multivariate analysis, age, preoperative doses of insulin, and preoperative oral antidiabetics showed positive correlation to metabolic nonresponse after surgery (*p = 0.04; *p = 0.021; *p = 0.021). Metabolic failure rate was lower after Roux-en-Y gastric bypass compared to other bariatric procedures (**p = 0.008).


A long history of preoperative T2DM, high preoperative HbA1c levels, and a preoperative therapy consisting of diverse approaches to diabetes treatment may be factors predicting failure of diabetes improvement in the early postoperative course after bariatric surgery. Age, preoperative insulin, and oral antidiabetic medication can be regarded as independent, significant predictors for metabolic outcome after bariatric surgery.


Metabolic surgery Diabetes mellitus Improvement Glycemic control Nonresponse 


Conflict of interest

All authors declare to have no conflict of interest.


  1. 1.
    Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236(5):554–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care. 2008;31 Suppl 2:290–6.CrossRefGoogle Scholar
  3. 3.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRefGoogle Scholar
  4. 4.
    Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251(3):399–405.PubMedCrossRefGoogle Scholar
  5. 5.
    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15(7):539–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Rosenstock J, Banarer S, Fonseca VA, et al. The 11-beta-hydroxysteroid dehydrogenase type 1 inhibitor INCB13739 improves hyperglycemia in patients with type 2 diabetes inadequately controlled by metformin monotherapy. Diabetes Care. 2010;33(7):1516–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese Type 2 diabetes(1). Diabet Med. 2011;28(6):628–42.Google Scholar
  8. 8.
    Gregg EW, Cheng YJ, Narayan KM, et al. The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976–2004. Prev Med. 2007;45(5):348–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic Roux-en-Y gastric bypass for BMI < 35 kg/m2: a tailored approach. Surg Obes Relat Dis. 2006;2(3):401–4. discussion 04.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Scopinaro N, Adami GF, Papadia FS, et al. Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35. Ann Surg. 2011;253(4):699–703.PubMedCrossRefGoogle Scholar
  12. 12.
    de Paula AL, Macedo AL, Prudente AS, et al. Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”)—pilot study of a new operation. Surg Obes Relat Dis. 2006;2(4):464–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Gianos M, Abdemur A, Fendrich I, et al. Outcomes of bariatric surgery in patients with body mass index <35 kg/m2. Surg Obes Relat Dis. 2011;8(1):25–30.Google Scholar
  14. 14.
    Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with BMI <35 kg/m2. Diabetes Obes Metab. 2011;14(3):262–70.Google Scholar
  15. 15.
    Hall TC, Pellen MG, Sedman PC, et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg. 2010;20(9):1245–50.PubMedCrossRefGoogle Scholar
  16. 16.
    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):467–84. discussion 84-5.PubMedGoogle Scholar
  17. 17.
    Huang CK, Shabbir A, Lo CH, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25–35. Obes Surg. 2011;21(9):1344–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Hamza N, Abbas MH, Darwish A, et al. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis. 2011;7(6):691–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Shukla AP, Ahn SM, Patel RT, et al. Surgical treatment of type 2 diabetes: the surgeon perspective. Endocrine. 2011;40(2):151–61.PubMedCrossRefGoogle Scholar
  20. 20.
    Rubino F, Schauer PR, Kaplan LM, et al. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.PubMedCrossRefGoogle Scholar
  21. 21.
    Benaiges D, Goday A, Ramon JM, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis. 2011;7(5):575–80.PubMedCrossRefGoogle Scholar
  22. 22.
    Lakdawala MA, Bhasker A, Mulchandani D, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg. 2010;20(1):1–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147(5):664–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • C. Jurowich
    • 1
    Email author
  • A. Thalheimer
    • 1
  • D. Hartmann
    • 1
  • G. Bender
    • 2
  • F. Seyfried
    • 1
  • C. T. Germer
    • 1
  • C. Wichelmann
    • 1
  1. 1.Department of General, Visceral, Vascular and Pediatric Surgery, Centre for Obesity and Metabolic SurgeryUniversity Hospital of WürzburgWürzburgGermany
  2. 2.Department of Endocrinology, Clinic for Internal MedicineUniversity Hospital of WürzburgWürzburgGermany

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