Mohamed AbdAlla Salman1, Ahmed Rabiee2, Ahmed Salman3, Ahmed Elewa4, Mohamed Tourky5, Ahmed Abdelrahman Mahmoud6, Ahmed Moustafa7, Hossam El-Din Shaaban8, Ahmed Abdelaziz Ismail9, Khaled Noureldin10, Mohamed Issa11, Mohamed Farah12, Hesham Barbary13, Mujahid Gasemelseed Fadlallah Elhaj14, Haitham S E Omar15. 1. General Surgery Department, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address: Mohammed.salman@kasralainy.edu.eg. 2. Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address: Ahmedrabeeh2020@yahoo.com. 3. Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address: Awea844@gmail.com. 4. General Surgery Department, National Hepatology and Tropical Medicine Research Institute, Egypt. Electronic address: Drelewa@outlook.com. 5. General Surgery Department, Great Western Hospital, NHS Foundation Trust, UK. Electronic address: sabry763@yahoo.com. 6. General Surgery Department, Great Western Hospital, NHS Foundation Trust, UK. Electronic address: Ahmed.mahmoud3@nhs.net. 7. Endemic Medicine and Hepatology Department, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address: Ahmedmoustafarefaat@yahoo.com. 8. Gastroenterology and Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Egypt. Electronic address: hsshaaban@aol.com. 9. Lecturer of Anesthesia and Pain Management, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address: Ahmed.abdelaziz81@yahoo.com. 10. General Surgery Department, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address: kangom1384@yahoo.com. 11. Speciality Doctor in Colorectal and General Surgery Prince Charles Hospital Myrthyer Tydfil, Cardiff, UK. Electronic address: Mohmed.talaat94@yahoo.com. 12. Sunderland Royal Hospital, UK. Electronic address: Mohamed.Farah@doctors.org.uk. 13. General and Laparoscopic Surgery Specialist at Alzytoun Specialized Hospital, Egypt. Electronic address: Heshamhamdallah89@gmail.com. 14. General Surgery Department, Saudi German Hospital, Saudi Arabia. Electronic address: mujahidelhaj@gmail.com. 15. General Surgery Department, Kasralainy School of Medicine, Cairo University, Egypt. Electronic address: haitham_omar1@yahoo.com.
Abstract
PURPOSE: Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures. METHODS: This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n = 83) and sleeve gastrectomy (LSG, n = 68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission. RESULTS: Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p < 0.001, for both), higher C-peptide and GLP-1 levels (p < 0.001 and p = 0.002, respectively), and bypass surgery (p = 0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR. CONCLUSION: Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.
PURPOSE: Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures. METHODS: This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n = 83) and sleeve gastrectomy (LSG, n = 68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission. RESULTS: Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p < 0.001, for both), higher C-peptide and GLP-1 levels (p < 0.001 and p = 0.002, respectively), and bypass surgery (p = 0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR. CONCLUSION: Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.
Authors: Alanoud Aladel; Alice M Murphy; Jenny Abraham; Neha Shah; Thomas M Barber; Graham Ball; Vinod Menon; Milan K Piya; Philip G McTernan Journal: Nutrients Date: 2022-05-13 Impact factor: 6.706