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11-27-2019 | Metabolic surgery | Highlight | News

Preoperative diabetes duration may affect remission rates after bariatric surgery

medwireNews: Swedish research suggests that determining type 2 diabetes duration prior to bariatric surgery could help prioritize those patients most likely to achieve diabetes remission.

The investigators found that patients with recent onset of diabetes were the most likely to achieve remission, with the likelihood of being medication-free at 2 and 5 years after surgery decreasing by 20% and 24%, respectively, with each additional year lived with the condition.

After accounting for confounding factors, the likelihood of achieving complete remission within 2 years of surgery decreased by 13% for each year spent with diabetes, and being treated with insulin decreased this prospect by 75%.

The registry-based study of 8546 adults with a BMI of at least 35 kg/m2 who underwent bariatric surgery between 2007 and 2015 found that 76.6% of the 8489 patients analyzed for pharmaceutical use at 2 years had remission from diabetes and no longer needed to take any medication for the condition. This was also the case for 69.9% of 5388 patients analyzed at 5 years.

In addition, 58.2% of the 3594 patients for whom glycated hemoglobin (HbA1c) levels were available at 2 years and 46.6% of 1460 with levels measured at 5 years achieved complete remission at this time point, being medication-free with an HbA1c level below 42 mmol/mol.

In addition to diabetes duration, age and baseline HbA1c influenced patients’ likelihood of achieving complete remission, with the chance decreasing by 6% with every extra year of age and by 2% for each additional mmol/mol in HbA1c.

By contrast, men were 57% more likely, on average, to achieve complete remission than women, while there was a 7% greater likelihood with each additional kg/m2 in preoperative BMI.

The findings come from the Scandinavian Obesity Surgery Registry, in which 8112 (94.9%) patients underwent a gastric bypass procedure and 434 (5.1%) underwent a sleeve gastrectomy.

The mean age of participants at baseline was 47.8 years, and mean BMI was 42.2 kg/m2; 61.7% were women, and average HbA1c was 58.9 mmol/mol. The patients’ BMI decreased by an average of 11.9 kg/m2 at 2 years and 10.7 kg/m2 at 5 years.

Overall, 4192 (49.1%) patients were solely taking oral diabetes medication at baseline, 453 (5.3%) received just insulin, 14 (0.2%) used a glucagon-like peptide-1 analog alone and 1973 (23.1%) received both oral treatment and insulin.

Reporting in PLOS Medicine, Erik Stenberg (Örebro University, Sweden) and colleagues conclude: “The relationship between preoperative diabetes duration and chance of diabetes remission is valuable in analyzing the potential benefit compared to risk related to bariatric surgery, and can therefore be used to prioritize for surgery those patients who are most likely to achieve diabetes remission.”

By Anita Chakraverty

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

PLOS Med 2019; 16: e1002985

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