Pedro Souteiro1,2,3, Sandra Belo4,5, Daniela Magalhães4,6,7, Jorge Pedro4,6,7, João Sérgio Neves4,6,7, Sofia Castro Oliveira4,6,7, Paula Freitas4,6,7,5, Ana Varela4,6,7,5, Davide Carvalho4,6,7. 1. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal. pedrobsouteiro@gmail.com. 2. Faculty of Medicine of University of Porto, Porto, Portugal. pedrobsouteiro@gmail.com. 3. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal. pedrobsouteiro@gmail.com. 4. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal. 5. Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal. 6. Faculty of Medicine of University of Porto, Porto, Portugal. 7. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
Abstract
BACKGROUND/ OBJECTIVES: Bariatric surgery leads to type 2 diabetes mellitus (T2DM) remission, but recurrence can ensue afterwards. However, literature provides heterogenous remission/recurrence criteria and there is no consensus on long-term T2DM management after surgery. We aim to assess T2DM remission/recurrence rates using standardized criteria and to identify relapse predictors. We also intend to analyze the management of residual T2DM and the impact of maintaining/withdrawing metformin in avoiding future relapse. SUBJECTS/ METHODS: We investigated a cohort of 110 obese patients with T2DM who underwent bariatric surgery and were followed for 5 years (Y0-Y5). Patients who ever attained remission were accounted for cumulate remission, while prevalent remission was considered for individuals who were on remission in a specific visit. RESULTS: A complete prevalent remission of 47.3% was reached at Y1 and it remained stable till Y5 (46.4-48.2%). Complete cumulative rate was of 57.3% at Y5. Five-year T2DM recurrence rate was 15.9% and it was associated with higher pre-operative HbA1c levels (β = 1.06; p < 0.05) and a milder excess body weight loss (EBWL) (β = 0.49; p < 0.05). Glucose-lowering agents were fully stopped in 51.4% of the patients till Y1 and in 16.2% of them afterwards. Medication withdrawal was mainly attempted in patients with a lower baseline HbA1c (β = 0.54; p < 0.01) and higher first-year EBWL (β = 1.04; p < 0.01). Patients that kept metformin after reaching a HbA1c in the complete remission range (<6.0%) did not have greater odds of avoiding relapse in the next visit (OR = 0.33; p = 0.08). CONCLUSIONS: Baseline HbA1c and EBWL were the main variables driving both T2DM relapse after bariatric surgery and the attempt to withdrawal anti-diabetic medication. In our population keeping metformin once an HbA1c < 6.0% is achieved did not seem to diminish relapse but further studies on this matter are needed.
BACKGROUND/ OBJECTIVES: Bariatric surgery leads to type 2 diabetes mellitus (T2DM) remission, but recurrence can ensue afterwards. However, literature provides heterogenous remission/recurrence criteria and there is no consensus on long-term T2DM management after surgery. We aim to assess T2DM remission/recurrence rates using standardized criteria and to identify relapse predictors. We also intend to analyze the management of residual T2DM and the impact of maintaining/withdrawing metformin in avoiding future relapse. SUBJECTS/ METHODS: We investigated a cohort of 110 obesepatients with T2DM who underwent bariatric surgery and were followed for 5 years (Y0-Y5). Patients who ever attained remission were accounted for cumulate remission, while prevalent remission was considered for individuals who were on remission in a specific visit. RESULTS: A complete prevalent remission of 47.3% was reached at Y1 and it remained stable till Y5 (46.4-48.2%). Complete cumulative rate was of 57.3% at Y5. Five-year T2DM recurrence rate was 15.9% and it was associated with higher pre-operative HbA1c levels (β = 1.06; p < 0.05) and a milder excess body weight loss (EBWL) (β = 0.49; p < 0.05). Glucose-lowering agents were fully stopped in 51.4% of the patients till Y1 and in 16.2% of them afterwards. Medication withdrawal was mainly attempted in patients with a lower baseline HbA1c (β = 0.54; p < 0.01) and higher first-year EBWL (β = 1.04; p < 0.01). Patients that kept metformin after reaching a HbA1c in the complete remission range (<6.0%) did not have greater odds of avoiding relapse in the next visit (OR = 0.33; p = 0.08). CONCLUSIONS: Baseline HbA1c and EBWL were the main variables driving both T2DM relapse after bariatric surgery and the attempt to withdrawal anti-diabetic medication. In our population keeping metformin once an HbA1c < 6.0% is achieved did not seem to diminish relapse but further studies on this matter are needed.
Authors: Yoshihiko Tashiro; Qinghong Han; Yuying Tan; Norihiko Sugisawa; Jun Yamamoto; Hiroto Nishino; Sachiko Inubushi; Y U Sun; Guangwei Zhu; Hyein Lim; Takeshi Aoki; Masahiko Murakami; Michael Bouvet; Robert M Hoffman Journal: In Vivo Date: 2020 May-Jun Impact factor: 2.155
Authors: Sofia Castro Oliveira; J S Neves; P Souteiro; J Pedro; D Magalhães; V Guerreiro; R Bettencourt-Silva; M M Costa; A Varela; I Barroso; P Freitas; D Carvalho Journal: Obes Surg Date: 2020-02 Impact factor: 4.129
Authors: Erik Stenberg; Torsten Olbers; Yang Cao; Magnus Sundbom; Anders Jans; Johan Ottosson; Erik Naslund; Ingmar Näslund Journal: BMJ Open Diabetes Res Care Date: 2021-05
Authors: Marta Borges-Canha; João Sérgio Neves; Fernando Mendonça; Maria Manuel Silva; Cláudia Costa; Pedro M Cabral; Vanessa Guerreiro; Rita Lourenço; Patrícia Meira; Daniela Salazar; Maria João Ferreira; Jorge Pedro; Ebrahim Barkoudah; Ana Sande; Eva Lau; Selma B Souto; John Preto; Paula Freitas; Davide Carvalho Journal: Front Endocrinol (Lausanne) Date: 2021-08-12 Impact factor: 5.555