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Abstract

*Core Technology Facility, Centre for Diabetes & Endocrinology, Institute of Human Development, University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK; shazli.azmi@manchester.ac.uk Ardestani A, Rhoads D, Tavakkoli A. Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated Type 2 diabetes. Diabetes Care 38(4), 659–664 (2015). Ardestani et al. studied 3318 patients who underwent Roux-en-Y gastric bypass surgery (RYGB) and 1907 that had laparoscopic adjustable gastric banding (LAGB) with Type 2 diabetes mellitus (T2D) and were on insulin presurgery. They report that the proportion of insulin cessation in the RYGB was approximately twice that of the LAGB group in all four time points assessed after surgery, 1, 3, 6 and 12 months. Additionally, clinical remission of T2D was greater in the RYGB versus LAGB at all postoperative time points; 1 month (22.5 vs 7%), 3 months (34.4 vs 11.3%), 6 months (43.2 vs 16%) and 12 months (50.3 vs 19.3%). Weight loss was also greater in the RYGBtreated patients at all time points. Multiple regression analysis revealed that RYGB was a strong predictor of postoperative cessation of insulin therapy. Younger age and weight loss were weaker predictors of insulin cessation d uring the early stages. This study shows that even in subjects described as having ‘advanced diabetes’, based on the use of insulin therapy, may benefit from RYGB through remission of T2D. If this does not occur they may have cessation of insulin therapy. A limitation of the study is that the HbA1C, duration of diabetes, fasting blood glucose or dose of insulin was not assessed in the database used. This meant that the authors evaluated diabetes remission through a categorical clinical evaluation scale to assess diabetes severity. – Written by Shazli Azmi