Objective
Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors.
Background
Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown.
Methods
Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed.
Results
At a median follow-up of 6 years (range: 5–9) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% ± 1.5% to 6.5% ± 1.2% (P < 0.001) and FBG from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P < 0.001). Long-term complete and partial remission rates were 24% and 26%, respectively, whereas 34% improved (>1% decrease in A1C without remission) from baseline and 16% remained unchanged. Shorter duration of T2DM (P < 0.001) and higher long-term EWL (P = 0.006) predicted long-term remission. Recurrence of T2DM after initial remission occurred in 19% and was associated with longer duration of T2DM (P = 0.03), less EWL (P = 0.02), and weight regain (P = 0.015). Long-term control rates of low high-density lipoprotein, high low-density lipoprotein, high triglyceridemia, and hypertension were 73%, 72%, 80%, and 62%, respectively. Diabetic nephropathy regressed (53%) or stabilized (47%).
Conclusions
Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.
Despite several papers having been published on the association between adiposity and the risk of metabolic syndrome (MetS), it is still difficult to determine unambiguously which of the indices of nutritional status is the best to identify MetS. The aim of this study was to analyze the ability of six anthropometric indices to identify MetS in the Polish population. The highest odds ratios for the occurrence of MetS, according to International Diabetes Federation (IDF), were noted for the following indices: waist-to-height ratio (WHtR, OR = 24.87) and Clínica Universidad de Navarra-body adiposity estimator (CUN-BAE, OR = 17.47) in men and WHtR (OR = 25.61) and body roundness index (BRI, OR = 16.44) in women. The highest odds ratios for the modified definition of MetS (without waist circumference) were found for the following indices: WHtR (OR = 7.32), BRI (OR = 6.57), and CUN-BAE (OR = 6.12) in women and CUN-BAE (OR = 5.83), WHtR (OR = 5.70), and body mass index (BMI, OR = 5.65) in men (p < 0.001 for all). According to the Receiver Operating Characteristic (ROC) analyses conducted for the identification of MetS, defined in accordance with IDF, the largest areas under the curve (AUCs) in men were observed for WHtR and CUN-BAE indices, whereas in women, they were observed for WHtR and BRI. In the analysis carried out for the identification of MetS (according to modified definition, without waist circumference), the AUCs were larger for WHtR and BRI in women, while in men, they were larger for CUN-BAE, BMI, and WHtR. BMI was also characterized by a relatively strong discriminatory power in identifying individuals with MetS. An optimal cut-off point for MetS, in accordance with the conventional definition, for both sexes was the value of BMI = 27.2 kg/m2. The weakest predictor of the syndrome was the ABSI (a body shape index) indicator. The most useful anthropometric indicator for the identification of MetS, both in men and in women in the Polish population, was WHtR. The optimal cut-off points for WHtR equaled 0.56 in men and 0.54 in women.
IntroductionGastric bypass is today the most frequently performed bariatric procedure,but,
despite of it, several complications can occur with varied morbimortality.
Probably all bariatric surgeons know these complications, but, as bariatric
surgery continues to spread, general surgeon must be familiarized to it and its
management. Gastric bypass complications can be divided into two groups: early and
late complications, taking into account the two weeks period after the surgery.
This paper will focus the early ones.MethodLiterature review was carried out using Medline/PubMed, Cochrane Library, SciELO,
and additional information on institutional sites of interest crossing the
headings: gastric bypass AND complications; follow-up studies AND complications;
postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative
complications. Search language was English.ResultsThere were selected 26 studies that matched the headings. Early complications
included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal
obstruction and incorrect Roux limb reconstruction.ConclusionsKnowledge on strategies on how to reduce the risk and incidence of complications
must be acquired, and every surgeon must be familiar with these complications in
order to achieve an earlier recognition and perform the best intervention.
IntroductionGastric bypass is today the most frequently performed bariatric procedure, but,
despite of it, several complications can occur with varied morbimortality.
Probably all bariatric surgeons know these complications, but, as bariatric
surgery continues to spread, general surgeon must be familiarized to it and its
management. Gastric bypass complications can be divided into two groups: early and
late complications, taking into account the two weeks period after the surgery.
This paper will focus the late ones.MethodLiterature review was carried out using Medline/PubMed, Cochrane Library, SciELO,
and additional information on institutional sites of interest crossing the
headings: gastric bypass AND complications; follow-up studies AND complications;
postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative
complications. Search language was English.ResultsThere were selected 35 studies that matched the headings. Late complications were
considered as: anastomotic strictures, marginal ulceration and gastrogastric
fistula.ConclusionKnowledge on strategies on how to reduce the risk and incidence of complications
must be acquired, and every surgeon must be familiar with these complications in
order to achieve an earlier recognition and perform the best intervention.
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