Five-Year Glycemic and Metabolic Outcomes after Bariatric Surgery in an Asian Population with Type 2 Diabetes

Abstract

Background: Metabolic-bariatric surgery (MBS) leads to durable weight loss and significant metabolic improvement in type 2 diabetes mellitus (T2DM) patients with obesity. However, data on durability of control is often lacking in Asia. Aim: We report 5-year glycemic and metabolic outcomes in a T2DM cohort who had MBS from 2008-2012 at a tertiary center in Singapore. Methodology: Patient demographics and biochemical parameters were retrieved from a web-based data repository. DM remission was defined as HbA1c ≤6% without DM medications. Results: There were 59 patients with a mean age of 43.0±9.5 years and 37.3% were males (Table 1). Most (76.3%) had gastric bypass while 23.7% had sleeve gastrectomy. Baseline mean weight and BMI were 114.4±27.4 kg and 42.5±10.5 kg/m2 respectively. Mean weight loss of 26% was achieved at 1 year and sustained over 5 years. Mean HbA1c decreased from 8.3% to 5.8% and 6.3% at 1 and 5 years respectively, with use of fewer DM, anti-hypertensive and lipid-lowering medications. At 5 years, 18 of 43 (41.9%) patients achieved sustained remission of diabetes with 6 (14.0%) having relapse of DM after initial remission at 1 year. Conclusion: MBS is effective therapy for obesity and DM with durable glycemic and metabolic control associated with lower medication use over 5 years in this Asian population.Table 1. Characteristics of subjects at baseline and over 5-year follow upPatient characteristicsPre-surgery (n=59)12 months (n=47)24 months (n=40)36 months (n=37)48 months (n=38)60 months (n=43)GenderMaleFemale22(37.3%)37(62.7%)NANANANANAAge (years)43.0 ± 9.5NANANANANAEthnicityChineseMalayIndianOther24 (40.7%)20 (33.9%)14 (23.7%)1 (1.7%)NANANANANADiabetes mellitus duration (months)92.1±96.3NANANANANATypes of surgerySleeve gastrectomyMini gastric bypassRoux-en-Y gastric bypass14(23.7%)16(27.1%)29(49.2%)NANANANANAWeight (kg)114.4±27.484.9±20.5*84.5±21.0*87.5±23.0*83.0±19.9*83.8±21.5*Body Mass Index (BMI) (%)42.5±10.531.9±8.3*31.3±7.4*32.5±8.2*31.3±8.06*32.0±8.67*Systolic blood pressure (mmHg)127.0±14.6125.6±17.3125.8±18.2130.2±17.7129.7±13.3135.4±19.2Diastolic blood pressure (mmHg)77.0±9.577.5±11.878.3±10.880.5±8.778.8±10.775.8±8.7Fasting blood glucose (mmol/L)8.51±3.125.51±1.93*5.99±2.11*6.59±2.57*6.72±2.51*6.73±2.55*HbA1c (%)8.32±1.385.82±0.82*6.09±1.09*6.51±1.31*6.53±1.11*6.32±1.02*Lipid panel (mmol/L)Total cholesterolLDLTriglycerideHDL4.56±0.882.75±0.811.69±0.741.05±0.264.77±0.942.83±0.611.19±0.56*1.32±0.29*4.81±0.77*2.84±0.731.30±0.51*1.46±0.54*4.79±0.86*2.78±0.701.42±0.68*1.37±0.32*4.54±0.912.52±0.801.41±0.76*1.38±0.28*4.17±0.522.28±0.451.30±0.70*1.30±0.28*Number of DM medications1.90±1.030.42±0.79*0.31±0.68*0.45±0.93*0.57±1.10*0.60±1.19*Antihypertensive medications1.64±1.210.42±0.70*0.39±0.72*0.37±0.79*0.40±0.83*0.45±0.95*Lipid-lowering medications0.81±0.570.17±0.38*0.25±0.44*0.31±0.50*0.27±0.49*0.33±0.51*Diabetes remission (n)NA2824121218Continuous data as mean ± SD; categorical data as n (%)* Presence of significant difference when compared to pre-surgery data (p<0.05) Disclosure Z. Liew: None. A. Maung: None. S. Ganguly: Advisory Panel; Self; Novo Nordisk Inc.. P. Lee: None. K. Tham: None.