Type 2 diabetes after gastric bypass: remission in five models using HbA1c, fasting blood glucose, and medication status

Blackstone, Robin P.; Bunt, Joy C.; Celaya, Melisa P; Sugerman, Harvey J.

doi:10.1016/j.soard.2012.05.005

Cited by 111 publications

(80 citation statements)

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“…In the surgical population as a whole and in agreement with the literature (9)(10)(11)(12), the longer the diabetes duration before bariatric surgery and the lower usage of antidiabetic drugs, particularly insulin, the lower the diabetes remission rate. The metric duration of the clinical diagnosis of diabetes together with the type of medication used can be considered a surrogate measure of the preservation of islet secretory capacity, suggesting that the more severe the diabetes, the lower the remission rate.…”

Section: Discussionsupporting

confidence: 84%

Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery

et al. 2015

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OBJECTIVEEligibility criteria for bariatric surgery in diabetes include BMI ‡35 kg/m 2 and poorly controlled glycemia. However, BMI does not predict diabetes remission, and thus, predictors need to be identified. RESEARCH DESIGN AND METHODSSeven hundred twenty-seven patients were included in a database merged from the Swedish Obese Subjects (SOS) study and two randomized controlled studies, with 415 surgical and 312 medical patients in total. Bariatric operations were divided into gastric only (GO) and gastric plus diversion (GD). RESULTSSixty-four percent of patients in the surgical arm and 15.0% in the medical arm experienced diabetes remission (P < 0.001). GO yielded 60% remission, and GD yielded 76% remission. The best predictors of diabetes remission were lower baseline glycemia and shorter diabetes duration. However, when operation type was considered, GD predicted a higher likelihood of remission and greater weight loss. Patients in remission (responders) lost more weight (25% vs. 17%) and waist circumference (18% vs. 13%) and experienced better insulin sensitivity than nonresponders. CONCLUSIONSSurgery is more effective than medical treatment in achieving diabetes remission and tighter glycemic control. Shorter diabetes duration, lower fasting glycemia before surgery, and GD versus GO procedures independently predict higher rates of remission, whereas baseline HbA 1c and waist circumference predict improved glycemic control. The results show the advantage of an early operation together with better controlled glycemia on diabetes remission independently of BMI.The prospective, controlled Swedish Obese Subjects (SOS) study showed that the shortterm rate of remission of diabetes after bariatric surgery is 72% compared with 21% in subjects treated with conventional weight loss methods (1). Randomized controlled studies have revealed diabetes remission rates between 37% and 42% (2) to 73% (3), 24% and 38% (4), and 75% and 95% (5), depending on the criteria used to define diabetes remission and baseline patient characteristics, choice of surgical therapy, and duration of follow-up (1-3 years). Unfortunately, such differences in diabetes remission criteria obscure important questions regarding the determinants of diabetes remission, which in turn affect eligibility criteria for patient selection for bariatric surgery.Historically, only subjects with BMI $35 kg/m 2 in the presence of uncontrolled diabetes were considered as potential candidates for bariatric and metabolic

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Section: Discussionsupporting

confidence: 84%

Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery

et al. 2015

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“…Among morbidly obese patients with remission of diabetes at 2 years after metabolic/bariatric surgery involving RYGB, AGB and other procedures, T2D was reported to have reoccurred in 50% by 10 years' follow-up [30,46]. Re-emergence of T2D after metabolic/bariatric surgery has been potentially associated with several preoperative factors, including poor glycemic control, severity of b-cell dysfunction, T2D duration and insulin use as well as a host of postoperative factors, such as maladaptive eating leading to weight regain, time after surgery and definition of clinical T2D remission [51,52]. Even significant, surgically-induced weight loss need not be accompanied by any signs of improved glycemic control whatsoever [53].…”

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confidence: 99%

“…Even significant, surgically-induced weight loss need not be accompanied by any signs of improved glycemic control whatsoever [53]. These clinical data substantiate the existence of a substantial number of diabesity patients who had undergone metabolic/ bariatric surgery, yet would still be candidates for medical treatment with synthetic drugs to keep T2D in-check and help maintain glucose homeostasis due to lack of post-surgical T2D resolution.The resolution of T2D after metabolic/bariatric surgery is more likely to occur in diabesity patients whose T2D had been controlled by oral hypoglycemic medications, and poor preoperative glycemic control and insulin use are associated with increased chance of T2D recurrence after surgically improved glucose control [15,51,52]. These results suggest an important role for synthetic drugs in a positive post-surgical prognosis by limiting the degree of preoperative glucose dysregulation.…”

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confidence: 99%

“…The resolution of T2D after metabolic/bariatric surgery is more likely to occur in diabesity patients whose T2D had been controlled by oral hypoglycemic medications, and poor preoperative glycemic control and insulin use are associated with increased chance of T2D recurrence after surgically improved glucose control [15,51,52]. These results suggest an important role for synthetic drugs in a positive post-surgical prognosis by limiting the degree of preoperative glucose dysregulation.…”

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confidence: 99%

“…Although variable among studies, criteria for complete (surgical) remission of T2D generally include both evidence of normal glycemic control and discontinuation of all diabetes medications [9,16,52,54]. Yet, diabesity patients who show acute surgical improvement in glycemic indices may need to remain on some (usually, reduced) level of T2D pharmacotherapy for months to over 1 year post surgery, depending upon the surgical procedure employed [9,55,56].…”

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confidence: 99%

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Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery

Janero

2014

Expert Opinion on Drug Discovery

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Type 2 diabetes (T2D) --particularly with concurrent obesity ('diabesity') --is an intensifying global public-health problem. Medical needs and market opportunities in the T2D space have propelled discovery efforts aimed at inventing new synthetic T2D drugs differentiable by improved safety and efficacy and/ or the ability to modulate emerging T2D targets. Particularly for moderately and severely obese individuals, weight-loss (bariatric) surgery offers an effective means of reducing obesity-driven T2D that is superior in many respects to medical T2D management. Yet, not all overweight or obese individuals with T2D qualify for bariatric surgery, and current healthcare resources are inadequate for applying surgical T2D control to more than a very small segment of qualified patients. Bariatric surgery is no guarantee of 'curative' T2D abrogation, significant rates of T2D non-remission or re-emergence having been observed in diabesity patients following bariatric procedures. Preoperative glucose control by oral hypoglycemic drugs reduces the chance of T2D recurrence post-surgery, and diabesity patients in whom glycemic indices have been improved by bariatric surgery may still require some level of T2D pharmacotherapy. Laboratory and clinical data indicate that synthetic T2D drugs can improve T2D-related outcomes following bariatric procedures, and current T2D drug-discovery efforts are being informed by the metabolic advantages associated with bariatric surgery. These circumstances intensify the need for and extend the impact of T2D drug discovery by demonstrating multiple levels of interplay between medical and surgical approaches to improve the health of individuals with diabesity and, perhaps, approach the overarching goal of decreasing long-term cardiovascular mortality.Keywords: cardiovascular risk, diabesity, endocrine disease, glycemic control, insulin resistance, metabolic syndrome, obesity, vascular disease Expert Opin. Drug Discov. (2014) 9(3):221-228 BackgroundIn the November, 2013, issue of Expert Opinion on Drug Discovery, Safavi et al. [1] surveyed approved synthetic drugs and late-stage pipeline compounds as pharmacotherapeutics for type 2 diabetes (T2D). Concluding that 'finding new targets and ... synthetic methods' is the 'main goal in T2D drug discovery,' the authors mention in passing that weight-loss (bariatric) surgery 'is a highly effective treatment for obesity-related T2D.' This commentary aims to widen the aperture afforded by Safavi and colleagues by considering the proposition that the inability of bariatric surgery to eradicate the T2D pandemic expands the scope of and presents new opportunities for drug discovery in the T2D space. 221All rights reserved: reproduction in whole or in part not permitted 2. Bariatric surgery can effectively address, but has not solved, the T2D problemAn intensifying worldwide epidemic, obesity contributes to the development of numerous disabling and lifespan-limiting maladies. One of these, T2D, is well recognized as obesity's principal metabolic comorb...

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Clinical Factors Associated With Remission of Obesity-Related Comorbidities After Bariatric Surgery

et al. 2016

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Analysis of a large, representative administrative database confirmed established predictors and revealed novel variables associated with comorbidity remission after bariatric surgery. Incorporating these factors into clinical tools to assess an individual patient's risk-to-benefit profile for these procedures could enhance patient selection and the overall use of surgery for the treatment of obesity and metabolic disease.

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Type 2 diabetes after gastric bypass: remission in five models using HbA1c, fasting blood glucose, and medication status

Cited by 111 publications

References 45 publications

Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery

Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery

Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery

Clinical Factors Associated With Remission of Obesity-Related Comorbidities After Bariatric Surgery

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