medwireNews: Late relapse of type 2 diabetes is relatively common after bariatric surgery, but does not negate the metabolic health benefits of the procedure, a study shows.
“[R]elapse of [type 2 diabetes] years after bariatric surgery should not be considered a failure, since the trajectories of cardiometabolic risk factors, diabetes severity, and medication requirements are altered favorably after surgery,” say Ali Aminian (Cleveland Clinic, Ohio, USA) and co-researchers.
Indeed, they found that 77% of such patients within their cohort had “adequate” glycemic control after surgery, maintaining a median glycated hemoglobin (HbA1c) of 6.4% (46 mmol/mol), having had median pre-surgery levels of 7.2% (55 mmol/mol).
They also required fewer diabetes medications than before surgery, at a median of one versus two, and the proportion taking insulin was 12% compared with 29%. And these people also had significantly better blood pressure and lipid profiles than they had done prior to surgery.
“This is one of the first studies in the scientific literature to show statistically significant improvement in glycemic control, diabetes medication requirements, and other cardiovascular risk factors in the patients experiencing a relapse of [type 2 diabetes],” write the investigators in Diabetes Care.
The 136 people who relapsed comprised 32% of the total 425 people with type 2 diabetes who achieved remission within the first year after undergoing bariatric surgery at the Cleveland Clinic between 2004 and 2012. Relapse, during a minimum 5 years of follow-up, was defined as HbA1c of at least 6.5% (48 mmol/mol), fasting plasma glucose of at least 126 mg/dL, or renewed need for antidiabetes medication.
With the addition of another 319 surgery patients from three external sources, the researchers identified three independent predictive factors for diabetes relapse: a higher number of diabetes medications at baseline; longer preoperative diabetes duration; and undergoing sleeve gastrectomy rather than bypass surgery.
From these factors, the team created a “free user-friendly” risk prediction model for estimating late diabetes relapse risk and informing the choice between surgical procedures.
They say it can “assist in shaping patient expectations, informed consent process, decision-making, and evidence-based bariatric procedure selection.”
And the team created a second predictive model for use with people who achieve diabetes remission by 1 year after surgery. This model is based on preoperative diabetes duration and number of medications, plus the amount of weight loss at year 1 after surgery and subsequent weight regain, which were both significant predictors of diabetes relapse.
But even when relapse occurs, the researchers stress the generally improved metabolic outcomes and note that the “legacy effect” means that the time spent with good glycemic control may result in later reductions in the risk for micro- and macrovascular complications.
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