Douglas Barthold1, Elizabeth Brouwer1, Lee J Barton2, David E Arterburn3, Anirban Basu1,4, Anita Courcoulas5, Cecelia L Crawford6, Peter N Fedorka7, Heidi Fischer3, Benjamin B Kim8, Edward C Mun8, Sameer B Murali9, Kristi Reynolds2, Tae K Yoon2, Robert E Zane8, Karen J Coleman2. 1. 1Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA. 2. 2Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. 3. 3Kaiser Permanente Washington Health Research Institute, Seattle, WA. 4. 4Departments of Health Services and Economics, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA. 5. 5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. 6. 6Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA. 7. 7Department of Surgery, Kaiser Permanente San Bernardino Medical Center, Kaiser Permanente Southern California, Ontario, CA. 8. 8Department of Surgery, Kaiser Permanente South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, CA. 9. 9Center for Healthy Living, Kaiser Permanente San Bernardino Medical Center, Kaiser Permanente Southern California, Fontana, CA.
Abstract
OBJECTIVE: There are few studies testing the amount of weight loss necessary to achieve initial remission of type 2 diabetes mellitus (T2DM) following bariatric surgery and no published studies with use of weight loss to predict initial T2DM remission in sleeve gastrectomy (SG) patients. RESEARCH DESIGN AND METHODS: With Cox proportional hazards models we examined the relationship between initial T2DM remission and percent total weight loss (%TWL) after bariatric surgery. Categories of %TWL were included in the model as time-varying covariates. RESULTS: Of patients (N = 5,928), 73% were female; mean age was 49.8 ± 10.3 years and BMI 43.8 ± 6.92 kg/m2, and 57% had Roux-en-Y gastric bypass (RYGB). Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of T2DM (mean time to remission 1.0 year). With 0-5% TWL used as the reference group in Cox proportional hazards models, patients were more likely to remit with each 5% increase in TWL until 20% TWL (hazard ratio range 1.97-2.92). When categories >25% TWL were examined, all patients had a likelihood of initial remission similar to that of 20-25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0-5% TWL, even if they were using insulin at the time of surgery. CONCLUSIONS: Weight loss after bariatric surgery is strongly associated with initial T2DM remission; however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. Achieving this threshold is also associated with initial remission even in patients who traditionally experience lower rates of remission, such as patients taking insulin.
OBJECTIVE: There are few studies testing the amount of weight loss necessary to achieve initial remission of type 2 diabetes mellitus (T2DM) following bariatric surgery and no published studies with use of weight loss to predict initial T2DM remission in sleeve gastrectomy (SG) patients. RESEARCH DESIGN AND METHODS: With Cox proportional hazards models we examined the relationship between initial T2DM remission and percent total weight loss (%TWL) after bariatric surgery. Categories of %TWL were included in the model as time-varying covariates. RESULTS: Of patients (N = 5,928), 73% were female; mean age was 49.8 ± 10.3 years and BMI 43.8 ± 6.92 kg/m2, and 57% had Roux-en-Y gastric bypass (RYGB). Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of T2DM (mean time to remission 1.0 year). With 0-5% TWL used as the reference group in Cox proportional hazards models, patients were more likely to remit with each 5% increase in TWL until 20% TWL (hazard ratio range 1.97-2.92). When categories >25% TWL were examined, all patients had a likelihood of initial remission similar to that of 20-25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0-5% TWL, even if they were using insulin at the time of surgery. CONCLUSIONS: Weight loss after bariatric surgery is strongly associated with initial T2DM remission; however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. Achieving this threshold is also associated with initial remission even in patients who traditionally experience lower rates of remission, such as patients taking insulin.
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Authors: Karen J Coleman; Anirban Basu; Lee J Barton; Heidi Fischer; David E Arterburn; Douglas Barthold; Anita Courcoulas; Cecelia L Crawford; Benjamin B Kim; Peter N Fedorka; Edward C Mun; Sameer B Murali; Kristi Reynolds; Robert E Zane; Sami Alskaf Journal: JAMA Netw Open Date: 2022-09-01