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Determinants of type 2 diabetes remission after bariatric surgery in obese Japanese patients: a retrospective cohort study

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Abstract

Objective

Bariatric surgery (BS) improves glycemic control in type 2 diabetes; however, some patients show insufficient improvement. Understanding the pathophysiology of type 2 diabetes in obese patients can facilitate appropriate treatment for type 2 diabetes after BS. The homeostatic model assessment (HOMA) 2 enables the calculation of the values from C-peptide data and evaluation of insulin users. We aimed to evaluate the pathophysiology of type 2 diabetes using pre- and postoperative parameters and HOMA2 in obese patients who underwent BS.

Methods

We retrospectively reviewed data from 45 obese patients with type 2 diabetes who underwent BS. They were followed-up for 12 months. The relationship between the HOMA2 score and complete remission (CR) of type 2 diabetes after BS was analyzed. Patients with and without CR were assigned to the CR and non-CR groups, respectively. Multiple regression analysis was used to identify factors associated with improvement in type 2 diabetes after BS.

Results

BS significantly improved body weight and glucose metabolism. The preoperative glycosylated hemoglobin A1c level and insulin secretion (HOMA2-%B) significantly differed between the CR and non-CR groups. Postoperative weight reduction and improved insulin sensitivity correlated significantly with CR; multiple regression showed that the preoperative HOMA 2-%B independently predicted CR of type 2 diabetes after BS.

Conclusion

Preoperative insulin secretion, improvement in insulin sensitivity, and weight reduction after BS are related to CR of type 2 diabetes after BS. The results better reveal the pathophysiology of and treatment for type 2 diabetes in obese patients who undergo BS.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors are grateful to Dr. Daiji Nagayama (Nagayama Clinic, Oyama-city, Tochigi, Japan) for his assistance with statistical analysis and to Sayaka Tsuji (Center for Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, Sakura-City, Chiba, Japan), a coordinator, for her assistance with patient care. The authors are also grateful to the radiologists who measured the fat mass in this study.

Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. Center for Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-0841, Japan

    Masahiro Ohira, Yasuhiro Watanabe, Takashi Yamaguchi, Atsuhito Saiki, Shoko Nakamura, Shou Tanaka, Naomi Shimizu & Ichiro Tatsuno

  2. Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-0841, Japan

    Taiki Nabekura & Takashi Oshiro

Authors
  1. Masahiro Ohira
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  2. Yasuhiro Watanabe
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  3. Takashi Yamaguchi
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  4. Atsuhito Saiki
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  5. Shoko Nakamura
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  6. Shou Tanaka
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  7. Naomi Shimizu
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  8. Taiki Nabekura
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  9. Takashi Oshiro
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  10. Ichiro Tatsuno
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Contributions

All authors contributed to the study conception and design. MO contributed to the research concept and design, collection and/or assembly of data, data analysis, and writing of the article. YW, TY, AS, SN, ST, NS, TN, and TO contributed to data collection and/or collation. IT contributed to the interpretation of the results of data analysis and to the critical revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masahiro Ohira.

Ethics declarations

Conflicts of interest

The authors declare that they have no competing interests.

Research involving human participants and/or animals

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional) and/or with the Helsinki Declaration of 1964 and later versions. The protocol of the study was approved by the Ethics Committee of Toho University Sakura Medical Center (approval date; 28 November 2018, approval No.; S18061).

Informed consent

Although this was a retrospective study, patients were individually explained the issues relating to the use and release of the study data before the operation. Written consent was obtained in each case.

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Cite this article

Ohira, M., Watanabe, Y., Yamaguchi, T. et al. Determinants of type 2 diabetes remission after bariatric surgery in obese Japanese patients: a retrospective cohort study. Diabetol Int 12, 379–388 (2021). https://doi.org/10.1007/s13340-021-00493-7

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  • DOI: https://doi.org/10.1007/s13340-021-00493-7

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