Factors associated with complete and partial remission, improvement, or unchanged diabetes status of obese adults 1 year after sleeve gastrectomy

Abstract

Background: Laparoscopic sleeve gastrectomy (SG) achieves type 2 diabetes (T2D) remission to various extents, and reasons for such variations are unknown. Objectives: We assessed patients' characteristics associated with T2D remission 1 year post SG. Setting: University hospital. Methods: Retrospective study of 230 T2D patients (18-64 yr) who underwent SG at our institution. We examined pre-and postoperative demographic, anthropometric, biochemical, and clinical characteristics associated with T2D complete remission, partial remission, improvement, or unchanged status. Independent predictors of T2D complete remission were assessed by binary logistic regression and then included in 7 predictive models. Logistic regression assessed the pre-and postoperative predictors of T2D complete remission and their predictive performance was measured with the area under the curve of the receiver operating characteristic curve. Results: A total of 230 patients were included in the study, females comprised 69%, and mean age was 45.66 6 8.84 years. Mean preoperative weight and body mass index were 115.69 6 20.76 kg and 43.53 6 6.98 kg/m 2 , respectively. Approximately two thirds (64.4%) of the sample had diabetes for .5 years. Insulin therapy users comprised 36.9% of the sample and 29.6% of patients were on 2 oral hypoglycemic agents (OHA). At 1 year, mean body mass index was 32.77 6 6.09 kg/m 2 , percent excess weight loss (%EWL) was 62.29 6 23.60% and glycosylated hemoglobin (HbA1C) improved from 8.1% to 6.18%. Approximately 42.2% of the sample achieved T2D complete remission. Compared with those with no remission, patients with complete remission were significantly younger, had shorter duration of diabetes, were not on insulin therapy, took fewer OHA, had higher C-peptide, lower preoperative HbA1C, were less likely to have had hypertension or dyslipidemia, and more likely to have achieved higher %EWL. Seven proposed models for prediction of complete remission showed the most useful model comprised diabetes duration 1 pre-HbA1C 1 %EWL 1 insulin therapy 1 age 1 OHA (area under the curve 5 .81). Independent predictors of complete remission were preoperative HbA1C, %EWL, insulin therapy, age, and OHA (but not diabetes duration).

Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB): results of the longitudinal assessment of bariatric surgery study

“…1-year after surgery, we observed 74.8% complete remission and 5.7% partial remission rates. Complete remission level was more than those reported by other authors (42.2% [25], 68.91% [26], 74% [10]). On the other hand, the T2DM remission rate 3 years after bariatric surgery reported in this study is higher than rates reported in prospective and retrospective other cohort studies (79.4% at 3 years vs. 62-77%) [27,28].…”

Factors associated with resolution of type-2 diabetes mellitus after sleeve gastrectomy in obese adults

“…Previous studies investigating SG cases involved a Table 1. Determination of the status of type 2 diabetes 17 . HbA1c Glycated hemoglobin; FBG fasting blood glucose.…”

“…The current analysis adopted the standardized American Society of Bariatric and Metabolic Surgery definitions of evolution of T2D post-bariatric procedures 17 ( Table 1).…”

Laparoscopic Sleeve Gastrectomy: Outcomes, Safety and Complications

“…Several independent factors were identified as predictors of complete T2DM remission, including preoperative HbA1C, EWL%, insulin therapy, age, and oral hypoglycemic medications [11,16].…”