Type 2 Diabetes Remission 5 Years After Laparoscopic Sleeve Gastrectomy: Multicenter Cohort Study

Abstract

Purpose Bariatric surgery is no longer considered only as a weight loss surgery but also a way of treating obesity-related comorbidities such as type 2 diabetes mellitus (T2DM). Short-term T2DM remissions in patients undergoing laparoscopic sleeve gastrectomy (LSG) have been shown, but there are very few reports on the mid-term results. We aimed to assess the remission rate of T2DM in obese patients after LSG throughout 5-year follow-up. Materials and Methodology We performed a retrospective multicenter cohort analysis of 240 patients who underwent LSG. We assessed the remission rate of T2DM 1 year and 5 years after surgery. Results Forty-six percent of patients achieved T2DM remission 5 years after LSG. The remission group had better weight loss results (median% of total weight loss 5 years after: 30.1% (22.9–37.0) vs 23.0% (13.7–30.2), p < 0.001) and were significantly younger than the no remission group (43 (38–52) vs 52 (44–58) years, p < 0.001). Duration of T2DM was significantly shorter (2 (1–5) vs 5 (3–10) years, p < 0.001) with less insulin requirement and less diabetes-related complications (7.2% vs 19.8%, p < 0.001) and significantly lower median DiaRem score (4.0 (IQR 2.0–6.0) vs 12.0 (IQR 5.0–16.0), p < 0.001). Preoperative body mass index (BMI) had no effect on remission. Conclusions Our study suggests that diabetes remission after laparoscopic sleeve gastrectomy occurs frequently, and in the 5-year follow-up, it may remain at the level of 46%. We identified the age of patients, duration, and severity of T2DM as factors affecting mid-term diabetes remission. Nevertheless, further well-designed trials are needed to support our findings.

Impact of Gastropexy/Omentopexy on Gastrointestinal Symptoms after Laparoscopic Sleeve Gastrectomy

“…Laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly performed bariatric procedures and has been accepted by the American Society for Metabolic and Bariatric Surgery as a first-stage operation for morbidly obese patients [5,6].…”

Current Knowledge and Perceptions of Bariatric Surgery among Diabetologists and Internists in Poland

“…Specifically, there is unequivocal evidence that BS offers a safe and more effective alternative to intensive conservative treatment for achieving glycemic control in obese diabetic patients [ 23 ]. Interestingly, BS could also induce both short- and long-term diabetes remission [ 24 , 25 ]. Our respondents had a largely positive attitude to BS and supported the belief that BS is a valid treatment strategy for obese patients with both type 2 diabetes mellitus and metabolic syndrome.…”

Formulation and interpretation of the Chinese Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes Mellitus

“…According to DiaRem scoring, early remission was achieved in 88% (95% CI 83-92%) of patients with a score of 0-2 points, 64% (58-71%) of those with a score of 3-7 points, 23% (13-33%) of those with a score of 8-12 points, 11% (6-16%) of those with a score of 13-17 points, and 2% (0-5%) of those with a score of 18-22 points (Table 1). The DiaRem score was used to predict the rate of diabetes rate at 1 year post-RYGB, but it was not accurate for long-term predictions such as 5 years post-operatively or for other procedures (24).…”