Predictive Factors of Type 2 Diabetes Remission 1 Year After Bariatric Surgery: Impact of Surgical Techniques

Abstract

Type 2 diabetes (T2D) remission after bariatric procedures has been highlighted in many retrospective and some recent prospective studies. However, in the most recent prospective study, more than 50% of patients did not reach T2D remission at 1year. Our aim was to identify baseline positive predictors for T2D remission at 1year after bariatric surgery and to build a preoperative predictive score. We analysed the data concerning 161 obese operated on between June 2007 and December 2010. Among them, 46 were diabetic and were included in the study-11 laparoscopic adjustable gastric banding (LAGB), 26 Roux-en-Y gastric bypass (RYGB) and 9 sleeve gastrectomy (SG). We compared anthropometric and metabolic features during 1year of follow-up. A receiver operating characteristic analysis was performed to predict T2D remission. RYGB and SG were similarly efficient for body weight loss and more efficient than LAGB; 62.8% of patients presented with T2DM remission at 1year, with no significant difference according to the surgical procedure. A 1-year body mass index (BMI) <35kg m(-2) was predictive of T2DM remission whatever the procedure. The preoperative predictive factors of diabetes remission were baseline BMI ≤50kg m(-2), duration of type 2 diabetes ≤4years, glycated haemoglobin ≤7.1%, fasting glucose <1.14g/l and absence of insulin therapy. A short duration of diabetes and good preoperative glycaemic control increase the rate of T2DM remission 1year after surgery. Preoperative metabolic data could be of greater importance than the choice of bariatric procedure.