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Conversion from Prediabetes to Diabetes in Individuals with Obesity, 5-Years Post-Band, Sleeve, and Gastric Bypass Surgeries

  • Dror DickerEmail author
  • Doron S. Comaneshter
  • Rina Yahalom
  • Chagit Adler Cohen
  • Shlomo Vinker
  • Rachel Golan
Original Contributions

Abstract

Background

Identifying risk factors for conversion to diabetes among individuals with obesity and prediabetes is important for preventing diabetes.

Purpose

We assessed conversion rates to diabetes 5 years after three types of metabolic surgery and examined predictors of diabetes development.

Methods

We accessed data of individuals with prediabetes, defined as fasting glucose (FG) 100–125 mg/dL (5.6–6.9 mmol/L) or HbA1c 5.7–6.4% at baseline (preoperatively), who underwent metabolic surgeries in Clalit Health Services during 2002–2011.

Results

Of 1,756 individuals with prediabetes, 819 underwent gastric banding (GB), 845 sleeve gastrectomy (SG), and 92 Roux-en-Y gastric bypass (RYGB). Mean age was 41.6 years and 73.5% were women. Five years post-surgery, 177 (10.1%) had developed diabetes. Conversion rates by type of surgery were 14.4%, 6.3%, and 6.5% for GB, SG, and RYGB, respectively (p < 0.001). Conversion was more rapid following GB than SG or RYGB (χ2(2) = 29.67, p < 0.005). In a multiple-logistic-regression model, predictors of diabetes development 5 years postoperatively were (1) weight loss during the first postoperative year and (2) preoperative levels of both FG and HbA1c within the prediabetes range. Baseline weight, age, and sex, were not associated with conversion to diabetes. Conversion rates were lower (4.7%) five years postoperatively for patients who lost > 25% of their baseline weight, compared to those who lost less than 15% of their weight during the first postoperative year: (14.0% < 0.001).

Conclusions

Our findings emphasize the importance of preoperative glycemic control and weight loss during the first year postoperatively, for the long-term prevention of diabetes in patients with prediabetes undergoing metabolic surgery.

Keywords

Metabolic surgery Pre-diabetes Diabetes Obesity 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Lipska KJ, Inzucchi SE, Van Ness PH, et al. Elevated HbA1c and fasting plasma glucose in predicting diabetes incidence among older adults: are two better than one? Diabetes Care. 2013;36:3923–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Bancks MP, Odegaard AO, Koh WP, et al. Glycated hemoglobin and incident type 2 diabetes in singaporean chinese adults: the Singapore Chinese health study. PLoS One. 2015;10:e0119884.CrossRefPubMedGoogle Scholar
  3. 3.
    Kawahara T, Imawatari R, Kawahara C, et al. Incidence of type 2 diabetes in pre-diabetic Japanese individuals categorized by HbA1c levels: a historical cohort study. PLoS One. 2015;10:e0122698.CrossRefPubMedGoogle Scholar
  4. 4.
    Backman O, Bruze G, Näslund I, et al. Gastric bypass surgery reduces De novo cases of type 2 diabetes to population levels: a Nationwide cohort study from Sweden. Ann Surg. 2019;269:895–902.CrossRefPubMedGoogle Scholar
  5. 5.
    Long SD, O’Brien K, MacDonald Jr KG, et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. A longitudinal interventional study. Diabetes Care. 1994;17:372–5.CrossRefPubMedGoogle Scholar
  6. 6.
    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;222:339–52.CrossRefPubMedGoogle Scholar
  7. 7.
    de la Cruz-Munoz N, Messiah SE, Arheart KL, et al. Bariatric surgery significantly decreases the prevalence of type 2 diabetes mellitus and pre-diabetes among morbidly obese multiethnic adults: long-term results. J Am Coll Surg. 2011;212:505–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Wentworth JM, Hensman T, Playfair J, et al. Laparoscopic adjustable gastric banding and progression from impaired fasting glucose to diabetes. Diabetologia. 2014;57:463–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367:695–704.CrossRefPubMedGoogle Scholar
  10. 10.
    Dicker D, Yahalom R, Comaneshter DS, et al. Long-term outcomes of three types of bariatric surgery on obesity and type 2 diabetes control and remission. Obes Surg. 2016;26:1814–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Sjöholm K, Pajunen P, Jacobson P, et al. Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish obese subjects (SOS) study. Diabetologia. 2015;58:1448–53.CrossRefPubMedGoogle Scholar
  12. 12.
    Gerber P, Anderin C, Gustafsson UO, et al. Weight loss before gastric bypass and postoperative weight change: data from the Scandinavian obesity registry (SOReg). Surg Obes Relat Dis. 2016 Mar 1;12(3):556–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Zhou K, Wolski K, Malin SK, et al. Impact of weight loss trajectory following randomization to bariatric surgery on long-term diabetes glycemic and cardiometabolic parameters. Endocr Pract. 2019;Google Scholar
  14. 14.
    Courcoulas AP, King WC, Belle SH, et al. Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) study. JAMA Surg. 2018;153:427–34.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    Promintzer-Schifferl M, Prager G, Anderwald C, et al. Effects of gastric bypass surgery on insulin resistance and insulin secretion in nondiabetic obese patients. Obesity. 2011;19:1420–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Anderwald CH, Tura A, Promintzer-Schifferl M, et al. Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric roux-en-Y gastric bypass surgery. Diabetes Care. 2012;35:2580–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Holter MM, Dutia R, Stano SM, et al. Glucose metabolism after gastric banding and gastric bypass in individuals with type 2 diabetes: weight loss effect. Diabetes Care. 2017;40:7–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24:1005–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39:893–901.CrossRefPubMedGoogle Scholar
  21. 21.
    Garibay D, McGavigan AK, Lee SA, et al. β-cell glucagon-like peptide-1 receptor contributes to improved glucose tolerance after vertical sleeve gastrectomy. Endocrinology. 2016;157:3405–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373(1):11–22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine D, Hasharon HospitalRabin Medical CenterPetah TikvaIsrael
  2. 2.Sackler School of Medicine, TelAviv UniversityTel AvivIsrael
  3. 3.Central HeadquartersClalit Health ServicesTel AvivIsrael
  4. 4.Department of Public Health, Faculty of Health SciencesBen-Gurion University of the NegevBeer-ShevaIsrael

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