Refractory and new-onset diabetes more than 5 years after gastric bypass for morbid obesity

Yamaguchi, Camila M.; Faintuch, Joel; Hayashi, Silvia Yoko; Faintuch, Jacob J.; Cecconello, Ivan

doi:10.1007/s00464-012-2256-x

Cited by 14 publications

(11 citation statements)

References 15 publications

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“…Our results may partially be explained by the fact that on multivariable analysis, lower preoperative BMI was independently observed to be associated with diabetes responsive to surgery. Previous studies have observed similar associations between preoperative weight (25), postoperative weight loss (21), and diabetic cure. This association is presumed to occur secondary to changes in gut hormonal physiology (i.e., incretins, ghrelin, and glucagon-like peptide-1) induced by and in addition to the restrictive and upper gastrointestinal excluding properties intrinsic to gastric bypass (20, 30–42).…”

Section: Discussionmentioning

confidence: 56%

“…Previous studies have observed similar if not slightly higher percentages of diabetic cure rates ranging from 41–100% at 1-year (18–23), 75% at 2-year (24), 44–88% at 5-year (25–28), and 71–89% at 10-year follow-up (7–9). One possible explanation for this discrepancy may involve attrition rates, which are known to impact observed health outcomes (26, 29).…”

Section: Discussionmentioning

confidence: 69%

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Long-term diabetic response to gastric bypass

Davies

Efird

Guidry

et al. 2014

Journal of Surgical Research

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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.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 69%

Long-term diabetic response to gastric bypass

Davies

Efird

Guidry

et al. 2014

Journal of Surgical Research

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“…Recurrence rates of T2 DM come 5-10 years later, in a higher proportion (25-40%) [8]. This means that the initial promise of 470% "cure" of T2 DM regresses to 40-50%, compared to 490% with DS.…”

Section: Q6mentioning

confidence: 96%

Effect of sleeve gastrectomy on type 2 diabetes as an alternative to Roux-en-Y gastric bypass: a better long-term strategy

Gautier

2015

Surgery for Obesity and Related Diseases

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“…At 3 years after RYGB, T2D re-emerged or worsened in 24% of diabesity patients [48] and in 35% at 5 years post surgery [49]. Other studies report that recurrence of T2D after initial surgical remission was evident in 19% within a 5 --9-year follow-up range across various procedures [15] and 31.4% within 7 --9 years after RYGB [50]. Among morbidly obese patients with remission of diabetes at 2 years after metabolic/bariatric surgery involving RYGB, AGB and other procedures, T2D was reported to have reoccurred in 50% by 10 years' follow-up [30,46].…”

mentioning

confidence: 97%

Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery

Janero

2014

Expert Opinion on Drug Discovery

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Type 2 diabetes (T2D) --particularly with concurrent obesity ('diabesity') --is an intensifying global public-health problem. Medical needs and market opportunities in the T2D space have propelled discovery efforts aimed at inventing new synthetic T2D drugs differentiable by improved safety and efficacy and/ or the ability to modulate emerging T2D targets. Particularly for moderately and severely obese individuals, weight-loss (bariatric) surgery offers an effective means of reducing obesity-driven T2D that is superior in many respects to medical T2D management. Yet, not all overweight or obese individuals with T2D qualify for bariatric surgery, and current healthcare resources are inadequate for applying surgical T2D control to more than a very small segment of qualified patients. Bariatric surgery is no guarantee of 'curative' T2D abrogation, significant rates of T2D non-remission or re-emergence having been observed in diabesity patients following bariatric procedures. Preoperative glucose control by oral hypoglycemic drugs reduces the chance of T2D recurrence post-surgery, and diabesity patients in whom glycemic indices have been improved by bariatric surgery may still require some level of T2D pharmacotherapy. Laboratory and clinical data indicate that synthetic T2D drugs can improve T2D-related outcomes following bariatric procedures, and current T2D drug-discovery efforts are being informed by the metabolic advantages associated with bariatric surgery. These circumstances intensify the need for and extend the impact of T2D drug discovery by demonstrating multiple levels of interplay between medical and surgical approaches to improve the health of individuals with diabesity and, perhaps, approach the overarching goal of decreasing long-term cardiovascular mortality.Keywords: cardiovascular risk, diabesity, endocrine disease, glycemic control, insulin resistance, metabolic syndrome, obesity, vascular disease Expert Opin. Drug Discov. (2014) 9(3):221-228 BackgroundIn the November, 2013, issue of Expert Opinion on Drug Discovery, Safavi et al. [1] surveyed approved synthetic drugs and late-stage pipeline compounds as pharmacotherapeutics for type 2 diabetes (T2D). Concluding that 'finding new targets and ... synthetic methods' is the 'main goal in T2D drug discovery,' the authors mention in passing that weight-loss (bariatric) surgery 'is a highly effective treatment for obesity-related T2D.' This commentary aims to widen the aperture afforded by Safavi and colleagues by considering the proposition that the inability of bariatric surgery to eradicate the T2D pandemic expands the scope of and presents new opportunities for drug discovery in the T2D space. 221All rights reserved: reproduction in whole or in part not permitted 2. Bariatric surgery can effectively address, but has not solved, the T2D problemAn intensifying worldwide epidemic, obesity contributes to the development of numerous disabling and lifespan-limiting maladies. One of these, T2D, is well recognized as obesity's principal metabolic comorb...

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Refractory and new-onset diabetes more than 5 years after gastric bypass for morbid obesity

Abstract: This is the first investigation, to the best of our knowledge, to underscore the correlates of refractory and NOD within the bariatric context. Further studies are recommended as such information could be valuable for patient selection, prognostic scoring, and outcome monitoring.

Cited by 14 publications

References 15 publications

Long-term diabetic response to gastric bypass

Long-term diabetic response to gastric bypass

Effect of sleeve gastrectomy on type 2 diabetes as an alternative to Roux-en-Y gastric bypass: a better long-term strategy

Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery

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