Long-term diabetic response to gastric bypass

Abstract

BACKGROUND As obesity and type II diabetes continue to rise, bariatric surgery offers a solution, but few long-term studies are available. The purpose of this study was to evaluate the long-term outcomes of diabetic patients following gastric bypass. MATERIALS AND METHODS This was a retrospective cohort study of all diabetic patients undergoing gastric bypass at our institution, from 1998–2012. Patients were compared by postoperative diabetic response to treatment (i.e., response=off oral medication/insulin vs. refractory=on oral medication/insulin) and followed at 1-, 3-, 5-, and 10-year intervals. Continuous data were analyzed using Student’s t-test or Wilcoxon Rank Sum. Multivariable, Cox proportional-hazard regression was performed to compute diabetic cure ratios (CR) and 95% confidence intervals (CI). RESULTS A total of 2,454 bariatric surgeries were performed at our institution during the time period. 707 diabetic patients were selected by CPT codes for gastric bypass. Mean follow-up was 2.1 years. Incidence of diabetic response was 56% (1-year), 58% (3-year), 60% (5-year), and 44% (10-year). Postoperatively, responsive patients experienced greater percent total body weight loss [1-year (p<0.0001), 3-year (p=0.0087), and 5-year (p=0.013)], and less hemoglobin A1c levels [1-year (p=0.035) and 3-year (p=0.040)] at follow-up than refractory patients. Multivariable analysis revealed a significant, independent inverse trend in incidence of diabetic cure as both age and BMI decreased (Ptrend=0.0019 and <0.0001, respectively). Additionally, DJD was independently associated with responsive diabetes [CR=1.6 (95% CI=1.1–2.2)]. CONCLUSIONS At follow-up, both groups in our study experienced substantial weight loss; however, a greater loss was observed among the response group. Further research is needed to evaluate methods for optimizing patient care preoperatively and improving patient follow-up.

What is the impact of sleeve gastrectomy and gastric bypass on metabolic control of diabetes? A clinic-based cohort of Mediterranean diabetic patients

“…Our findings are consistent with those reported in recent clinical trials comparing bariatric surgery and intensive medical therapy alone. However, our data not only indicate a beneficial metabolic effect of bariatric surgery in diabetic patients but also importantly confirm clinical effectiveness in unselected patients [11][12][13][14][15][16]. It is noteworthy that mean diabetes duration was longer than in previous studies, suggesting that obese patients are delayed from undergoing bariatric surgery even after diabetes diagnosis in our clinical setting, thus hampering the likelihood of a complete restoration of β-cell function.…”

“…Weight loss surgeries also have beneficial glycemic effects that are independent of weight, likely due to favorable changes in gut hormone secretion [10]. Although bariatric surgery is emerging as the most effective treatment for selected obese diabetic patients, studies supporting a more extensive use of surgical approaches in obese diabetic patients have several limitations, such as the low number of studied patients and the short duration of follow-ups [11][12][13][14][15][16][17]. Furthermore, there is little information on the metabolic effects of laparoscopic sleeve gastrectomy as a stand-alone operation, which is emerging as an especially attractive procedure for high-risk patients [18][19][20].…”

Type 2 Diabetes Remission After Gastric Bypass: What Is the Best Prediction Tool for Clinicians?

“…Despite its recognized efficacy, operated patients respond differently to the intervention. T2D remission is observed in 41 to 100% of subjects after bypass surgery and the percentage of remission depends on the cohort under study as well as on the criteria used to define remission [4][5][6]. It is thus important for patients, clinicians and surgeons to identify methods that accurately predict patients' outcomes, and to test their relevance in clinical practice.…”

Vancomycin-Associated Nephrotoxicity: The Obesity Factor

“…More than one-third of American adults are obese (i.e., have a body mass index [BMI] >30 kg/m 2 ] [6,7]. Obesity has been linked to diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (i.e., metabolic syndrome) [8][9][10].…”