Dror Dicker1,2, Doron S Comaneshter3, Rina Yahalom3, Chagit Adler Cohen4, Shlomo Vinker3, Rachel Golan5. 1. Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, 7, Keren Kayemet St., 49100, Petah Tikva, Israel. daniel3@013.net. 2. Sackler School of Medicine, Tel, Aviv University, Ramat Aviv, Tel Aviv, Israel. daniel3@013.net. 3. Central Headquarters, Clalit Health Services, Tel Aviv, Israel. 4. Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, 7, Keren Kayemet St., 49100, Petah Tikva, Israel. 5. Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel.
Abstract
BACKGROUND: Identifying risk factors for conversion to diabetes among individuals with obesity and prediabetes is important for preventing diabetes. PURPOSE: We assessed conversion rates to diabetes 5 years after three types of metabolic surgery and examined predictors of diabetes development. METHODS: We accessed data of individuals with prediabetes, defined as fasting glucose (FG) 100-125 mg/dL (5.6-6.9 mmol/L) or HbA1c 5.7-6.4% at baseline (preoperatively), who underwent metabolic surgeries in Clalit Health Services during 2002-2011. RESULTS: Of 1,756 individuals with prediabetes, 819 underwent gastric banding (GB), 845 sleeve gastrectomy (SG), and 92 Roux-en-Y gastric bypass (RYGB). Mean age was 41.6 years and 73.5% were women. Five years post-surgery, 177 (10.1%) had developed diabetes. Conversion rates by type of surgery were 14.4%, 6.3%, and 6.5% for GB, SG, and RYGB, respectively (p < 0.001). Conversion was more rapid following GB than SG or RYGB (χ2(2) = 29.67, p < 0.005). In a multiple-logistic-regression model, predictors of diabetes development 5 years postoperatively were (1) weight loss during the first postoperative year and (2) preoperative levels of both FG and HbA1c within the prediabetes range. Baseline weight, age, and sex, were not associated with conversion to diabetes. Conversion rates were lower (4.7%) five years postoperatively for patients who lost > 25% of their baseline weight, compared to those who lost less than 15% of their weight during the first postoperative year: (14.0% < 0.001). CONCLUSIONS: Our findings emphasize the importance of preoperative glycemic control and weight loss during the first year postoperatively, for the long-term prevention of diabetes in patients with prediabetes undergoing metabolic surgery.
BACKGROUND: Identifying risk factors for conversion to diabetes among individuals with obesity and prediabetes is important for preventing diabetes. PURPOSE: We assessed conversion rates to diabetes 5 years after three types of metabolic surgery and examined predictors of diabetes development. METHODS: We accessed data of individuals with prediabetes, defined as fasting glucose (FG) 100-125 mg/dL (5.6-6.9 mmol/L) or HbA1c 5.7-6.4% at baseline (preoperatively), who underwent metabolic surgeries in Clalit Health Services during 2002-2011. RESULTS: Of 1,756 individuals with prediabetes, 819 underwent gastric banding (GB), 845 sleeve gastrectomy (SG), and 92 Roux-en-Y gastric bypass (RYGB). Mean age was 41.6 years and 73.5% were women. Five years post-surgery, 177 (10.1%) had developed diabetes. Conversion rates by type of surgery were 14.4%, 6.3%, and 6.5% for GB, SG, and RYGB, respectively (p < 0.001). Conversion was more rapid following GB than SG or RYGB (χ2(2) = 29.67, p < 0.005). In a multiple-logistic-regression model, predictors of diabetes development 5 years postoperatively were (1) weight loss during the first postoperative year and (2) preoperative levels of both FG and HbA1c within the prediabetes range. Baseline weight, age, and sex, were not associated with conversion to diabetes. Conversion rates were lower (4.7%) five years postoperatively for patients who lost > 25% of their baseline weight, compared to those who lost less than 15% of their weight during the first postoperative year: (14.0% < 0.001). CONCLUSIONS: Our findings emphasize the importance of preoperative glycemic control and weight loss during the first year postoperatively, for the long-term prevention of diabetes in patients with prediabetes undergoing metabolic surgery.
Authors: Miriam Promintzer-Schifferl; Gerhard Prager; Christian Anderwald; Martina Mandl; Harald Esterbauer; Soheila Shakeri-Leidenmühler; Giovanni Pacini; Marietta Stadler; Martin G Bischof; Bernhard Ludvik; Aanton Luger; Michael Krebs Journal: Obesity (Silver Spring) Date: 2011-04-14 Impact factor: 5.002
Authors: Marlena M Holter; Roxanne Dutia; Sarah M Stano; Ronald L Prigeon; Peter Homel; James J McGinty; Scott J Belsley; Christine J Ren; Daniel Rosen; Blandine Laferrère Journal: Diabetes Care Date: 2016-11-08 Impact factor: 19.112
Authors: Nestor de la Cruz-Muñoz; Sarah E Messiah; Kristopher L Arheart; Gabriela Lopez-Mitnik; Steven E Lipshultz; Alan Livingstone Journal: J Am Coll Surg Date: 2011-04 Impact factor: 6.113
Authors: Keren Zhou; Kathy Wolski; Steven K Malin; Ali Aminian; Philip R Schauer; Deepak L Bhatt; Sangeeta R Kashyap Journal: Endocr Pract Date: 2019-03-13 Impact factor: 3.443
Authors: Lena M S Carlsson; Markku Peltonen; Sofie Ahlin; Åsa Anveden; Claude Bouchard; Björn Carlsson; Peter Jacobson; Hans Lönroth; Cristina Maglio; Ingmar Näslund; Carlo Pirazzi; Stefano Romeo; Kajsa Sjöholm; Elisabeth Sjöström; Hans Wedel; Per-Arne Svensson; Lars Sjöström Journal: N Engl J Med Date: 2012-08-23 Impact factor: 91.245
Authors: W J Pories; M S Swanson; K G MacDonald; S B Long; P G Morris; B M Brown; H A Barakat; R A deRamon; G Israel; J M Dolezal Journal: Ann Surg Date: 1995-09 Impact factor: 12.969
Authors: Olof Backman; Gustaf Bruze; Ingmar Näslund; Johan Ottosson; Richard Marsk; Martin Neovius; Erik Näslund Journal: Ann Surg Date: 2019-05 Impact factor: 12.969
Authors: Xavier Pi-Sunyer; Arne Astrup; Ken Fujioka; Frank Greenway; Alfredo Halpern; Michel Krempf; David C W Lau; Carel W le Roux; Rafael Violante Ortiz; Christine Bjørn Jensen; John P H Wilding Journal: N Engl J Med Date: 2015-07-02 Impact factor: 91.245