Vanessa Lopes Preto de Oliveira1,2, Gianluca P Martins3, Cláudio C Mottin4, Jacqueline Rizzolli5,4, Rogério Friedman6,3,7. 1. Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, Brazil. vanessa.endocrino@gmail.com. 2. Division of Endocrinology, Hospital São Lucas da Pontifícia Universidade do Rio Grande do Sul, Av. Ipiranga, 6690, Sala 220, 2° andar, Porto Alegre, RS, 90610-000, Brazil. vanessa.endocrino@gmail.com. 3. Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, Brazil. 4. Obesity and Metabolic Syndrome Center, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6.690, Centro Clínico da PUC, 3°andar, Sala 302, Porto Alegre, Brazil. 5. Division of Endocrinology, Hospital São Lucas da Pontifícia Universidade do Rio Grande do Sul, Av. Ipiranga, 6690, Sala 220, 2° andar, Porto Alegre, RS, 90610-000, Brazil. 6. Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, Brazil. 7. Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 Sala 401, Porto Alegre, Brazil.
Abstract
BACKGROUND: Diabetes remission is not observed in all obese patients with type 2 diabetes submitted to bariatric surgery. Relapses occur in patients in whom remission is achieved. We investigated the factors associated with long-term (≥3 years) remission and relapse of type 2 diabetes after Roux-en-Y gastric bypass (RYGB) in these patients. METHODS: By a retrospective review, we analyzed data from 254 patients with type 2 diabetes who had undergone RYGB from May 2000 to November 2011 and had at least 3 years of follow-up. The criteria for remission and relapse of type 2 diabetes followed the current American Diabetes Association recommendations. RESULTS: Remission was achieved in almost 82% of participants (69.7% complete, and 12.2% partial remission). Of these, 12% relapsed within a mean follow-up of 5.1 ± 2.0 years after surgery. Predictors of complete remission were younger age, better preoperative glycemic control, and shorter diabetes duration. Preoperative insulin use was associated with a ninefold increase in the relapse hazard (HR = 9.1 (95% CI: 3.3-25.4)). Use of two or more oral anti-diabetic agents increased the relapse hazard sixfold (HR = 6.1 (95% CI: 1.8-20.6)). Eighteen point one percent of patients did not achieve any remission during follow-up. However, they exhibited significant improvements in glycemic control. CONCLUSIONS: These data indicate that RYGB should not be delayed when remission of type 2 diabetes is a therapeutic goal, and also suggest that the best possible metabolic control should be sought in obese patients who may eventually be candidates for RYGB.
BACKGROUND:Diabetes remission is not observed in all obesepatients with type 2 diabetes submitted to bariatric surgery. Relapses occur in patients in whom remission is achieved. We investigated the factors associated with long-term (≥3 years) remission and relapse of type 2 diabetes after Roux-en-Y gastric bypass (RYGB) in these patients. METHODS: By a retrospective review, we analyzed data from 254 patients with type 2 diabetes who had undergone RYGB from May 2000 to November 2011 and had at least 3 years of follow-up. The criteria for remission and relapse of type 2 diabetes followed the current American Diabetes Association recommendations. RESULTS: Remission was achieved in almost 82% of participants (69.7% complete, and 12.2% partial remission). Of these, 12% relapsed within a mean follow-up of 5.1 ± 2.0 years after surgery. Predictors of complete remission were younger age, better preoperative glycemic control, and shorter diabetes duration. Preoperative insulin use was associated with a ninefold increase in the relapse hazard (HR = 9.1 (95% CI: 3.3-25.4)). Use of two or more oral anti-diabetic agents increased the relapse hazard sixfold (HR = 6.1 (95% CI: 1.8-20.6)). Eighteen point one percent of patients did not achieve any remission during follow-up. However, they exhibited significant improvements in glycemic control. CONCLUSIONS: These data indicate that RYGB should not be delayed when remission of type 2 diabetes is a therapeutic goal, and also suggest that the best possible metabolic control should be sought in obesepatients who may eventually be candidates for RYGB.
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