Simona Panunzi1, Lena Carlsson2, Andrea De Gaetano1, Markku Peltonen2, Toni Rice3, Lars Sjöström2, Geltrude Mingrone4, John B Dixon5. 1. CNR-Institute for Systems Analysis and Computer Science (IASI), BioMatLab, Rome, Italy. 2. Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. 3. Department of Internal Medicine, Catholic University, Rome, Italy. 4. Department of Internal Medicine, Catholic University, Rome, Italy Department of Diabetes and Nutritional Sciences, King's College London, London, U.K. gmingrone@rm.unicatt.it. 5. Obesity Research Unit, Department of General Practice, and Baker IDI Heart and Diabetes Institute, Monash University, Melbourne, Victoria, Australia.
Abstract
OBJECTIVE: Eligibility 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 METHODS: Seven 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). RESULTS: Sixty-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. CONCLUSIONS: Surgery 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 HbA1c 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.
OBJECTIVE: Eligibility 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 METHODS: Seven 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). RESULTS: Sixty-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. CONCLUSIONS: Surgery 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 HbA1c 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.
Authors: G Craig Wood; Daniel Horwitz; Christopher D Still; Tooraj Mirshahi; Peter Benotti; Manish Parikh; Annemarie G Hirsch Journal: Obes Surg Date: 2018-01 Impact factor: 4.129
Authors: Risa M Wolf; Kimberley E Steele; Leigh A Peterson; Xiange Zeng; Andrew E Jaffe; Michael A Schweitzer; Thomas H Magnuson; G William Wong Journal: J Clin Endocrinol Metab Date: 2016-03-16 Impact factor: 5.958
Authors: R Vilallonga; J L Pereira-Cunill; S Morales-Conde; I Alarcón; I Breton; E Domínguez-Adame; J V Ferrer; A Garcia Ruiz-de-Gordejuela; A Goday; A Lecube; E Martín García-Almenta; M Á Rubio; F J Tinahones; P P García-Luna Journal: Obes Surg Date: 2019-12 Impact factor: 4.129