Defining and Predicting Complete Remission of Type 2 Diabetes: A Short-Term Efficacy Study of Open Gastric Bypass

Abstract

Objective: To investigate the metabolic effects of open Roux-en Y gastric bypass (RYGB) on pancreatic endocrine reserve in overweight/obese Chinese patients with type 2 diabetes during postoperative year 1. Methods: Retrospective analysis comparing pre- and postoperative results of oral glucose tolerance tests (OGTT) with determinations of insulin and C-peptide, glycated hemoglobin (HbA1c), insulin resistance (HOMA-IR), and BMI at 1, 3, 6, and 12 months in 99 overweight patients (BMI 26.3 ± 4.0 kg/m²; 59 men) with type 2 diabetes at the General Hospital of Chengdu Military Region. Results: 79 patients (80%) achieved complete remission (maintaining random blood glucose levels < 11.1 mmol/l, fasting blood glucose levels < 7.0 mmol/l, 2-hour OGTT blood glucose levels < 11.1 mmol/l, and glycated hemoglobin < 6.5%). Nine cases (9%) were ‘improved' (reduced medication or diet controlled blood sugar), and 11 cases did not meet either criterion (‘unchanged'). Patients in complete remission were younger and heavier, more often men, had significantly shorter history of diabetes (4.3 ± 3.8 years vs. 7.6 ± 3.8 years, p < 0.05), and exhibited significantly higher fasting and OGTT levels of C-peptide and insulin, and HOMA-IR than the other 2 groups (p < 0.05-0.01). Conclusion: Open gastric bypass achieved complete remission of type 2 diabetes in Chinese overweight/obese, heavier, younger, predominantly male patients with shorter duration of disease exhibiting greater pancreatic endocrine reserve.

Predictive Factors of Type 2 Diabetes Mellitus Remission Following Bariatric Surgery: a Meta-analysis

“…The 15 eligible articles included a total of 1,753 T2DM patients [ 8 – 22 ]. Most studies were conducted in the USA (seven), with the others conducted in Brazil (one), Taiwan (one), Italy (one), Korea (one), China (one), Spain (two), and New Zealand (one).…”

“…A total of 149 T2DM patients in two Asian studies were included in the meta-analysis of the relationship between baseline C-peptide levels and T2DM remission [ 16 , 22 ]. Our meta-analysis showed a significant association between baseline C-peptide levels and T2DM remission (random model, OR = 0.62, 95 % CI = 0.33 to 0.91, P < 0.01).…”

“…A total of 1,113 T2DM patients in 13 studies were included in the meta-analysis of the relationship between gender and T2DM remission [ 8 , 10 , 11 , 13 – 17 , 19 – 22 ]. Of these, seven studies were conducted in the USA, three in Asia, one in Oceania, and two in Europe.…”

Comparison of the effects of Roux-en-Y gastrojejunostomy and LRYGB with small stomach pouch on type 2 diabetes mellitus in patients with BMI<35 kg/m2

“…The effectiveness of the surgery for T2DM was assessed based on the DM remission criterion recommended by the international diabetes federation (IDF) (postoperative FBG o7.0 mmol/L, 2-h OGTT blood glucose levels o11.1 mmol/L, and HbA 1c o6.5% without DM medications) [5]. BMI, HbA 1c , HOMA-IR, waist circumference, FBG, PBG, and body fat content were measured 6 and 12 months after the surgery.…”

Expression of MicroRNA-448 and SIRT1 and Prognosis of Obese Type 2 Diabetic Mellitus Patients After Laparoscopic Bariatric Surgery

“…It is likely not possible to use a single agent to control glycemia and body weight; however, treatment with two or more agonists or single co-agonists is considered as a reasonable strategy for treating obesity and T2DM [3]. Compared with these combinatorial therapies and traditional therapies such as dietary modulation and conventional drug usage, which are correlated with poor long-term outcomes, laparoscopic bariatric surgery is much more efficient in losing weight [4]. Laparoscopic Roux-en-Y gastric bypass (LRYGB), which is a type of laparoscopic bariatric surgery, has been shown to be effective in the treatment of obstructive sleep apnea in obese T2DM patients [5].…”