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Diagnosis of Diabetes Remission After Bariatic Surgery May be Jeopardized by Remission Criteria and Previous Hypoglycemic Treatment

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Abstract

Background

Controversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients' baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin therapy (IT).

Methods

We performed a retrospective study from a cohort of 657 BS from a single center (2006–2011), of which 141 (57.4 % women) had T2D. We evaluated anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. T2D remission was defined according to 2009 consensus criteria: HbA1c <6 %, fasting glucose (FG) <100 mg/dL, and absence of pharmacologic treatment. We analyzed diabetes remission according to previous treatment.

Results

Preoperative characteristic were (mean ± SD): age 53.9 ± 9.8 years, BMI 43.7 ± 5.6 kg/m2, T2D duration 7.4 ± 7.6 years, FG 160.0 ± 54.6 mg/dL, HbA1c 7.6 ± 1.6 %. Fifty-six (39.7 %) individuals had IT. At 1-year follow-up, 74 patients (52.5 %) had diabetes remission. Percentage weight loss (%WL) and percentage excess weight loss (%EWL) were associated to remission (35.5 ± 8.1 vs. 30.2 ± 9.5 %, p = 0.001; 73.6 ± 18.4 vs. 66.3 ± 22.8 %, p = 0.037, respectively). Duration of diabetes, age, and female sex were associated to nonremission: 10.3 ± 9.4 vs. 4.7 ± 3.8 years, p < 0.001; 55.1 ± 9.3 vs. 51.2 ± 9.9 years, p = 0.017; 58.9 vs. 33.3 %, p = 0.004, respectively. Prior treatment revealed differences in remission rates: 67.1 % in case of oral therapy (OT) vs. 30.4 % in IT, p < 0.001. OR for T2D remission in patients with previous IT, compared to those with only OT, were 0.157–0.327 (p < 0.05), adjusting by different models.

Conclusions

Consensus criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission.

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Acknowledgments

This study was funded by Fundación Mutua Madrileña de Investigación Biomédica AP 89592011.

Conflict of interest

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Authors and Affiliations

  1. Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense, C/ Prof. Martin Lagos s/n., Madrid, 28040, Spain

    Ana Ramos-Levi, Pilar Matia, Lucio Cabrerizo, Ana Barabash, Alfonso Calle-Pascual & Miguel Rubio

  2. Department of Surgery, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense, C/ Prof. Martin Lagos s/n., Madrid, 28040, Spain

    Andres Sanchez-Pernaute, Carmen Hernandez & Antonio Torres

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  1. Ana Ramos-Levi
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  9. Miguel Rubio
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Correspondence to Miguel Rubio.

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Ramos-Levi, A., Sanchez-Pernaute, A., Matia, P. et al. Diagnosis of Diabetes Remission After Bariatic Surgery May be Jeopardized by Remission Criteria and Previous Hypoglycemic Treatment. OBES SURG 23, 1520–1526 (2013). https://doi.org/10.1007/s11695-013-0995-y

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