Katharina Laubner1, Nicole Prinz2,3, Joachim Brückel4, Andreas Serwas5, Marcus Altmeier6, Reinhard Welp7, Dietmar Krakow8, Felix Groß9, Esther Bollow2,3, Jochen Seufert10, Reinhard W Holl2,3. 1. Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Katharina.laubner@uniklinik-freiburg.de. 2. Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany. 3. German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. 4. Clinic for Internal Medicine, Oberschwabenklinik Wangen, Wangen, Germany. 5. Clinic for Internal Medicine, Herz-Jesu-Krankenhaus Muenster-Hiltrup, Muenster, Germany. 6. Diabeteszentrum am Klinikum Dortmund, Dortmund, Germany. 7. Clinic for Internal Medicine, Knappschaftskrankenhaus Bottrop, Bottrop, Germany. 8. Diabeteszentrum Forchheim, Forchheim, Germany. 9. Diabetologische Schwerpunktpraxis, Murnau am Staffelsee, Germany. 10. Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Abstract
INTRODUCTION: Bariatric surgery is a well-established treatment option for serious obesity and concomitant type 2 diabetes mellitus (T2DM). In this analysis, we investigated predictors for bariatric surgery in everyday clinical practice. MATERIALS AND METHODS: In the DPV-registry, patients with T2DM from Germany and Austria treated by bariatric surgery were compared to non-surgery controls by descriptive statistics and regression analysis. RESULTS: Among 277,862 patients with T2DM, 0.07% underwent bariatric surgery. Surgery patients were predominantly female [61.20%], younger [median age (Q1;Q3) 54.74(47.40;61.61) vs. 70.04 (60.36;77.58) years] and had a longer diabetes duration [11.21 (7.15;17.93) vs. 8.36 (2.94;14.91) years]. They had a higher BMI [40.02 vs. 30.61 kg/m2, adjusted p < 0.0001] and a slightly lower HbA1c [7.25 vs. 7.56%, adjusted p < 0.05]. There was a trend using more often insulin therapy (52.79 vs.50.08%, n.s.) with no difference in insulin dose/kg × day [0.56 vs. 0.58, n.s.]. Sleeve gastrectomy was performed most frequently, followed by Roux-en-Y gastric bypass, gastric banding, gastric balloon and others. A 2-year follow-up data in 29 patients demonstrated significant reductions in BMI [45.23 to 38.00 kg/m2, p < 0.005] and HbA1c [7.98 to 6.98%, p < 0.005], and a trend for reduced insulin requirements [62.07 vs. 44.83%, n.s.]. CONCLUSION: Despite favourable 2-year outcomes, bariatric surgery is still used rarely in patients with T2DM and obesity. BMI rather than metabolic control seems to represent the major selector for or against bariatric surgery in T2DM.
INTRODUCTION: Bariatric surgery is a well-established treatment option for serious obesity and concomitant type 2 diabetes mellitus (T2DM). In this analysis, we investigated predictors for bariatric surgery in everyday clinical practice. MATERIALS AND METHODS: In the DPV-registry, patients with T2DM from Germany and Austria treated by bariatric surgery were compared to non-surgery controls by descriptive statistics and regression analysis. RESULTS: Among 277,862 patients with T2DM, 0.07% underwent bariatric surgery. Surgery patients were predominantly female [61.20%], younger [median age (Q1;Q3) 54.74(47.40;61.61) vs. 70.04 (60.36;77.58) years] and had a longer diabetes duration [11.21 (7.15;17.93) vs. 8.36 (2.94;14.91) years]. They had a higher BMI [40.02 vs. 30.61 kg/m2, adjusted p < 0.0001] and a slightly lower HbA1c [7.25 vs. 7.56%, adjusted p < 0.05]. There was a trend using more often insulin therapy (52.79 vs.50.08%, n.s.) with no difference in insulin dose/kg × day [0.56 vs. 0.58, n.s.]. Sleeve gastrectomy was performed most frequently, followed by Roux-en-Y gastric bypass, gastric banding, gastric balloon and others. A 2-year follow-up data in 29 patients demonstrated significant reductions in BMI [45.23 to 38.00 kg/m2, p < 0.005] and HbA1c [7.98 to 6.98%, p < 0.005], and a trend for reduced insulin requirements [62.07 vs. 44.83%, n.s.]. CONCLUSION: Despite favourable 2-year outcomes, bariatric surgery is still used rarely in patients with T2DM and obesity. BMI rather than metabolic control seems to represent the major selector for or against bariatric surgery in T2DM.
Entities:
Keywords:
Bariatric surgery; Medical treatment; Type 2 diabetes mellitus
Authors: Stacy A Brethauer; Ali Aminian; Héctor Romero-Talamás; Esam Batayyah; Jennifer Mackey; Laurence Kennedy; Sangeeta R Kashyap; John P Kirwan; Tomasz Rogula; Matthew Kroh; Bipan Chand; Philip R Schauer Journal: Ann Surg Date: 2013-10 Impact factor: 12.969
Authors: Beat P Müller-Stich; Jonas D Senft; René Warschkow; Hannes G Kenngott; Adrian T Billeter; Gianmatteo Vit; Stefanie Helfert; Markus K Diener; Lars Fischer; Markus W Büchler; Peter P Nawroth Journal: Ann Surg Date: 2015-03 Impact factor: 12.969
Authors: Philip R Schauer; Deepak L Bhatt; John P Kirwan; Kathy Wolski; Stacy A Brethauer; Sankar D Navaneethan; Ali Aminian; Claire E Pothier; Esther S H Kim; Steven E Nissen; Sangeeta R Kashyap Journal: N Engl J Med Date: 2014-03-31 Impact factor: 91.245
Authors: Ted D Adams; Lance E Davidson; Sheldon E Litwin; Ronette L Kolotkin; Michael J LaMonte; Robert C Pendleton; Michael B Strong; Russell Vinik; Nathan A Wanner; Paul N Hopkins; Richard E Gress; James M Walker; Tom V Cloward; R Tom Nuttall; Ahmad Hammoud; Jessica L J Greenwood; Ross D Crosby; Rodrick McKinlay; Steven C Simper; Sherman C Smith; Steven C Hunt Journal: JAMA Date: 2012-09-19 Impact factor: 56.272
Authors: Massimo F Piepoli; Arno W Hoes; Stefan Agewall; Christian Albus; Carlos Brotons; Alberico L Catapano; Marie-Therese Cooney; Ugo Corrà; Bernard Cosyns; Christi Deaton; Ian Graham; Michael Stephen Hall; F D Richard Hobbs; Maja-Lisa Løchen; Herbert Löllgen; Pedro Marques-Vidal; Joep Perk; Eva Prescott; Josep Redon; Dimitrios J Richter; Naveed Sattar; Yvo Smulders; Monica Tiberi; H Bart van der Worp; Ineke van Dis; W M Monique Verschuren; Simone Binno Journal: Eur Heart J Date: 2016-05-23 Impact factor: 29.983
Authors: Francesco Rubino; David M Nathan; Robert H Eckel; Philip R Schauer; K George M M Alberti; Paul Z Zimmet; Stefano Del Prato; Linong Ji; Shaukat M Sadikot; William H Herman; Stephanie A Amiel; Lee M Kaplan; Gaspar Taroncher-Oldenburg; David E Cummings Journal: Diabetes Care Date: 2016-06 Impact factor: 19.112
Authors: Hannes G Kenngott; Gabriella Clemens; Matthias Gondan; Jonas Senft; Markus K Diener; Gottfried Rudofsky; Peter P Nawroth; Markus W Büchler; Lars Fischer; Beat P Müller-Stich Journal: Trials Date: 2013-06-20 Impact factor: 2.279