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Clinical factors that predict remission of diabetes after different bariatric surgical procedures


The aims of the study were to investigate weight loss and glycemic control parameters after different bariatric surgical procedures in type 2 diabetes ( T2D ) obese patients and identify patients' factors that predict diabetes remission.

The study included 105 obese patients with type 2 diabetes ( 66 women and 39 men ) who underwent laparoscopic gastric banding ( LAGB, 11 subjects, age 47 ± 10 years, body mass index [ BMI ] 42.3 ± 8.3 kg/m2 ), or laparoscopic Roux-en-Y gastric bypass ( RYBP, 77 subjects, age 50 ± 8 years, BMI 45.7 ± 6.8 kg/m2 ), or sleeve gastrectomy ( SG, 17 subjects, age 49 ± 11 years, BMI 50.2 ± 8.8 kg/m2 ) during 2005-2012 period.

The average percentage of weight loss at 12 months after surgery was 26.4 ± 9.8 %, and it was maintained at 24 and 36 months of follow-up.

Diabetes remission occurred in 68.6 % of study participants ( 4/11 of LAGB, 54/77 of RYBP and 14/17 of SG ).

In multivariate Cox analysis, age, duration of diabetes, surgical procedure and glycated hemoglobin less than 53 mmol/mol ( 7% ) resulted significant predictors of diabetes remission ( age RR = 0.97, 95 % CI 0.94-1.0, p = 0.05; diabetes duration RR = 0.93, 95 % CI 0.86-0.99, p = 0.036; rif LAGB, RYBP RR = 3.9, 95 % CI 1.31-11.57, p = 0.014; SG RR = 5.6, 95 % CI 1.67-18.64, p = 0.005; glycated hemoglobin RR = 0.54, 95 % CI 0.32-0.92, p = 0.024 ).

In conclusion, bariatric surgical procedures that modify the upper gastrointestinal tract anatomy ( laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy ) are more successful in producing weight loss and remission of type 2 diabetes mellitus than those that simply restrict stomach capacity ( laparoscopic gastric banding ).
Younger age, short duration of diabetes and better glucose control confer higher probability of achieving remission of diabetes. ( Xagena )

Zenti MG et al, Acta Diabetol 2015; Epub ahead of print

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