The association between microvascular and macrovascular diseases and diabetes remission after bariatric surgery

Ghusn, Wissam; Salame, Marita; Sayegh, Lea; Hage, Karl; Storm, Andrew C.; Dayyeh, Barham K. Abu; Ghanem, Omar M.

doi:10.1007/s00464-024-10687-0

Surg Endosc

2024

DOI: 10.1007/s00464-024-10687-0

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The association between microvascular and macrovascular diseases and diabetes remission after bariatric surgery

Wissam Ghusn,

Marita Salame,

Lea Sayegh

et al.

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Cited by 4 publications

References 20 publications

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Shedding more than weight: Metabolic and bariatric surgery and the journey to insulin independence in insulin-treated type 2 diabetes

Abi Mosleh,

Ghusn,

Salameh

et al. 2024

Journal of Gastrointestinal Surgery

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Shedding more than weight: Metabolic and bariatric surgery and the journey to insulin independence in insulin-treated type 2 diabetes

Abi Mosleh,

Ghusn,

Salameh

et al. 2024

Journal of Gastrointestinal Surgery

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Impact of metabolic and bariatric surgery on weight loss and insulin requirements in type 1 and insulin‐treated type 2 diabetes

Abi Mosleh,

Salameh,

Ghusn

et al. 2024

Clinical Obesity

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SummaryMetabolic and Bariatric Surgery (MBS) is effective in improving metabolic outcomes and reducing weight in patients with obesity and diabetes, with less explored benefits in type 1 diabetes (T1D). This study aimed to evaluate the impact of MBS on weight loss and insulin requirements in T1D patients compared to insulin‐treated type 2 diabetes (T2D) patients over a 5‐year period. This retrospective analysis included patients who underwent primary sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB) with a confirmed preoperative diagnosis of either T1D or insulin‐treated T2D. Primary endpoints focusing on weight loss and secondary outcomes assessing changes in insulin dosage and glycemic control. After 5 years, weight loss was similar across groups, with total weight loss at 14.2% for T1D and 17.6% for insulin‐treated T2D in SG, and 22.6% for T1D vs. 26.8% for insulin‐treated T2D in RYGB. Additionally, there was a significant reduction in median daily insulin doses from 140.5 units at baseline to 77.5 units at 1 year postoperatively, sustained at 90 units at 5 years. The differential impact of MBS procedure was also highlighted, where RYGB patients showed a more pronounced and enduring decrease in insulin requirements compared to SG.

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Using Pre-operative Insulin Dose to Predict Diabetes Remission After Roux-En-Y Gastric Bypass and Sleeve Gastrectomy

Ghusn,

Salameh,

Abi Mosleh

et al. 2024

Surg Innov

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Background Obesity is intricately associated with type-2 diabetes (T2D) and other cardiovascular conditions, increasing morbidity, mortality, and health care costs. Metabolic and bariatric surgeries (MBS) have shown promising results in significant weight loss and T2D remission, but existing predictive scores for post-MBS diabetes remission do not consider insulin dosage, potentially overlooking a critical factor. Methods A retrospective analysis of patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). The study focused on insulin dosage impact, divided into quartiles, on remission rates post-MBS. The effectiveness of RYGB vs SG was compared within insulin dose quartiles with up to 5 years of follow up. Results A total of 508 patients (64% female, 94.9% White, mean age 53.5 ± 10.5 years, BMI (46.0 ± 8.3 kg/m2) were included in the analysis. This study demonstrates a profound association between insulin dosage quartiles and T2D remission after MBS. Patients with lower insulin requirements showed superior remission rates; those in the lowest quartile had remission rates of 73%, 70%, and 62% at 1, 3, and 5 years, respectively, compared to 34%, 37%, and 36% in the highest quartile ( P < 0.001 across all intervals). RYGB surgery showed a significantly better remission in the second and third insulin quartiles, suggesting its effectiveness over SG for patients with mid-range insulin requirements. Conclusion This study underscores the importance of considering insulin dosage when predicting T2D remission post-MBS. The findings advocate for a more nuanced selection of MBS procedures based on individual insulin profiles, potentially enhancing diabetes remission outcomes.

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The association between microvascular and macrovascular diseases and diabetes remission after bariatric surgery

Cited by 4 publications

References 20 publications

Shedding more than weight: Metabolic and bariatric surgery and the journey to insulin independence in insulin-treated type 2 diabetes

Shedding more than weight: Metabolic and bariatric surgery and the journey to insulin independence in insulin-treated type 2 diabetes

Impact of metabolic and bariatric surgery on weight loss and insulin requirements in type 1 and insulin‐treated type 2 diabetes

Using Pre-operative Insulin Dose to Predict Diabetes Remission After Roux-En-Y Gastric Bypass and Sleeve Gastrectomy

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