Abstract
BackgroundObesity surgery has pronounced effects on metabolic profile of patients with type 2 diabetes mellitus (T2DM); however, reports on long-term remission rates based on the standardised and holistic criteria by the International Diabetes Federation (IDF) and effects on T2DM microvascular complications are scarce in the literature. In this retrospective clinical trial, our objectives were to assess these variables 5 years after surgery.MethodsClinical data and direct measurements of renal and retinal damage were collected prospectively and analysed retrospectively for 82 patients with T2DM who underwent obesity surgery and were followed up for 5 years.ResultsThe cohort of 82 patients with T2DM that were followed up 5 years after obesity surgery was predominantly female (71%) with a median age of 51 years, weight of 133.5 kg, BMI of 46.8 kg/m2 and pre-operative duration of T2DM of 8 years; 6% of patients had diet-controlled T2DM, 57% were on non-insulin treatment and 37% were on insulin treatment pre-operatively. Of the total 82 patients, 59 patients underwent Roux-en-Y gastric bypass, 15 sleeve gastrectomy and 8 patients underwent gastric band operations. At 5 years, 5% and 15% patients achieved optimisation and improvement of the metabolic state based on the IDF criteria respectively. Surgery was associated with almost halving of the albumin–creatinine ratio in 22 patients with pre-existing albuminuria (follow-up data available for 64 patients) and an overall stabilisation of retinopathy in 24 patients with retinal images available at 5 years.ConclusionWhilst the findings on microvascular complications are encouraging, the rates of metabolic remission were lower than expected and raise the need for validated protocols to assist clinicians in managing these patients more aggressively post-operatively to achieve optimum cardio-metabolic risk factor control and hopefully further reduction in microvascular and macrovascular complications.
Highlights
Obesity surgery has been shown to have impressive effects on the glycaemic control in obese patients with type 2 diabetes mellitus (T2DM) [1,2,3]; the definition of “diabetes remission” differs amongst the published RCTs
Evidence on 5-year T2DM “remission” rates using the International Diabetes Federation (IDF) criteria and on the effects of the most common obesity surgery procedures on microvascular complications using direct measurements is relatively scarce in the literature (e.g. [6, 7])
Our cohort of 82 patients with complete paired datasets at baseline and 5 years after obesity surgery was predominantly female (71%) with a median age of 51 years, median weight of 133.5 kg, median BMI of 46.8 kg/m2 and pre-operative duration of diabetes of 8 years; 72% underwent Roux-en-Y gastric bypass (RYGB) (n = 59), 18% underwent vertical sleeve gastrectomy (VSG) (n = 15) and 10% underwent gastric band (BAND) (n = 8)
Summary
Obesity surgery has been shown to have impressive effects on the glycaemic control in obese patients with type 2 diabetes mellitus (T2DM) [1,2,3]; the definition of “diabetes remission” differs amongst the published RCTs. Our primary aim was to assess the rates of T2DM patients achieving the IDF criteria 5 years after obesity surgery in order to evaluate its long-term metabolic effects. Obesity surgery has pronounced effects on metabolic profile of patients with type 2 diabetes mellitus (T2DM); reports on long-term remission rates based on the standardised and holistic criteria by the International Diabetes Federation (IDF) and effects on T2DM microvascular complications are scarce in the literature. In this retrospective clinical trial, our objectives were to assess these variables 5 years after surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
