Diabetes Remission Rate in Different Bmi Grades Following Roux-en-Y Gastric Bypass

Abstract

Background: Type 2 diabetes mellitus has a high long-term remission rate after laparoscopic Roux-en-Y gastric bypass (LRYGB), but few studies have analyzed patients with BMI<35 kg/m2. Aim: To compare glycemic control after LRYGB between BMI 30-35 kg/m2 (intervention group or IG) and >35 kg/m2 patients (control group or CG) and to evaluate weight loss, comorbidities and surgical morbidity. Methods: Sixty-six diabetic patients (30 in IG group and 36 in CG group) were submitted to LRYGB. Data collected annually after surgery were analyzed with generalized estimating equations. Results: Average follow-up was 4.3 years. There was no statistical difference between groups using complete remission American Diabetes Association criteria (OR 2.214, 95%CI 0.800-5.637, p=0.13). There was significant difference between groups using partial remission American Diabetes Association criteria (p=0.002), favouring the CG group (OR 6.392, 95%CI 1.922-21.260). The higher BMI group also had lower HbA1c levels (-0.77%, 95%CI -1.26 to -0.29, p=0.002). There were no significant differences in remission of hypertension, dyslipidemia and surgical morbidity, while weight was better controlled in the IG group. Conclusion: No differences were found in diabetes complete remission, although greater partial remission and the lower levels of glycated hemoglobin in the BMI >35 kg/m2 group suggest a better response among more obese diabetic patients with LRYGB. In addition, both groups had important metabolic modifications at the expense of low morbidity.

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…One study found that a composite scoring system (e.g., age, BMI, C‐peptide level, and duration of T2D) predicted response in glycemic markers to bariatric surgery . In another study, higher baseline BMI was associated with a greater improvement in T2D after RYGB . In any event, “remission” is the proper terminology as opposed to “cure,” since overt T2D returns in over half of these patients in less than 10 years .…”

“…However, the preponderance of studies in patients with class‐I obesity have focused on the clinical benefits of bariatric procedures in those patients with T2D. A substantial number of RCTs and cohort interventional trials have demonstrated that bariatric surgical procedures can effectively result in sustained improvement in glycemic control concomitant with reductions in diabetes medications in patients with BMI 30 to 34.9 kg/m 2 . Multiple meta‐analyses that specifically examined bariatric surgery outcomes in patients with BMI < 35 kg/m 2 have been published and support clinical benefits regarding glycemic control and weight loss .…”

The Impact of Bariatric Surgery on Weight Loss and Glycemic Control in Patients With Obesity and Type 2 Diabetes: A Systematic Review

“…Wang X et al (2016) [ 15 ] recorded a male participation of 42.8%, and Nguyen KT et al (2015) [ 18 ] noted a near-equal representation of 48.5% of males. Notably, several studies like Wallenius V et al (2015) [ 12 ], Seki Y et al (2022) [ 13 ], Coelho D et al (2018) [ 16 ], Ikramuddin S et al (2016) [ 17 ], and Petry TZ et al (2015) [ 19 ] did not specify the gender ratio. Study designs varied, with some following a prospective approach, some being retrospective, while others were randomized clinical trials or cohort studies.…”

“…The surgery was found to be notably effective for weight loss and improving glycemic control, especially for patients with higher BMI. Two studies, Coelho D et al [ 16 ] and Ikramuddin S et al [ 17 ], explored the long-term impacts of RYGB. Both studies highlighted the efficacy of RYGB in achieving diabetes treatment goals, with the latter also pointing out the risks associated with the procedure over time.…”

Weight Loss Comparison After Sleeve and Roux-en-Y Gastric Bypass: Systematic Review

“…Currently the two most commonly performed bariatric surgeries in the world are Roux-en-Y gastric bypass (BGYR) and vertical gastrectomy (GV) 2 . Despite many controversies regarding the comparison of techniques, both are safe and effective, however with slightly different comorbidities remission rates 3 , 6 , 18 .…”