Abstract
Although a large proportion of patients with type 2 diabetes (T2DM) who have undergone metabolic surgery experience initial remission some patients later suffer from relapse. While several factors associated with T2D remission are known, less is known about factors that may influence relapse. To identify possible risk factors for T2D relapse in patients who initially experienced remission. Nationwide, registry-based study. We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and body mass index ≥35 kg/m2 who received primary metabolic surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication. In total, 2090 patients in complete remission at 2 years after surgery were followed for a median of 5.9 years (interquartile range [IQR] 4.3-7.2 years) after surgery. The cumulative T2D relapse rate was 20.1%. Duration of diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.05-1.14; P < .001), preoperative glycosylated hemoglobin A1C (HbA1C) level (HR, 1.01; 95% CI, 1.00-1.02; P = .013), and preoperative insulin treatment (HR, 2.67; 95% CI, 1.84-3.90; P < .001) were associated with higher rates for relapse, while postoperative weight loss (HR, .93; 95% CI, .91-.96; P < .001), and male sex (HR, .65; 95% CI, .46-.91; P = .012) were associated with lower rates. Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.
Highlights
Obesity is a strong risk factor for developing type 2 diabetes (T2D) [1,2]
Previous studies have suggested that approximately 31%–35% of patients with initial remission later suffer from relapse and that the number of pre-operative diabetes medications and pre-operative T2D duration are risk factors [6,7]
8546 patients with T2D according to the definition of the American Diabetes Association were identified in SOReg
Summary
Obesity is a strong risk factor for developing type 2 diabetes (T2D) [1,2]. Bariatric surgery is currently the most effective way to achieve long-term weight loss as well as reduced mortality in individuals with severe obesity [3,4]. Some of the patients who initially achieve postoperative T2D remission later relapses [5,6]. Previous studies have suggested that approximately 31%–35% of patients with initial remission later suffer from relapse and that the number of pre-operative diabetes medications and pre-operative T2D duration are risk factors [6,7]. Knowledge of risk factors associated with T2D relapse could be used in a preoperative risk-benefit evaluation in patients with diabetes and severe obesity. The information could be used to design postoperative follow-up programs to identify patients with diabetes who relapse. The aim of the present study was to identify factors associated with T2D relapse in patients with severe obesity and T2D who have undergone metabolic surgery in Sweden
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