Presence of Liver Steatosis Is Associated With Greater Diabetes Remission After Gastric Bypass Surgery

Abstract

<b>Objective</b>: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and beta-cell dysfunction. Ectopic fat accumulation in liver and muscle causes IR. Since bariatric and metabolic surgery significantly improves fatty liver disease, <a>we hypothesized that coexistence of liver steatosis (i.e., when hepatic IR contributes in T2DM) would be associated with greater diabetes improvement after surgery.</a> <p> </p> <p><b>Research design and methods</b>: A total of 519 patients with T2DM who underwent Roux-en-Y gastric bypass and simultaneous liver biopsy and had a minimum 5-year follow-up were analyzed to assess the independent association between biopsy-proven liver steatosis and postoperative long-term diabetes remission (glycated hemoglobin < 6.5% off medications).</p> <p> </p> <p><b>Results</b>: Of the 407 patients with biopsy-proven liver steatosis, long-term diabetes remission was achieved in 211 (52%) patients, compared with 44/112 (39%) remission in patients without steatosis (P=0.027). In multivariable analysis, presence of liver steatosis was an independent predictor of long-term diabetes remission (odds ratio 1.96, [95% confidence interval 1.04 – 3.72], <i>P</i>=0.038). Hepatocyte ballooning, lobular inflammation, or fibrosis at baseline did not predict diabetes remission.</p> <p> </p> <p><b>Conclusion</b>: This study, for the first time, suggests that in patients with T2DM who are considering bariatric and metabolic surgery, coexistence of liver steatosis is associated with better long-term glycemic outcomes. Furthermore, our data suggest that there are different variants of T2DM wherein metabolic responses to surgical weight loss are different. A subgroup of patients whose T2DM is characterized by the presence of hepatic steatosis (presumably associated with worse IR) experience better postoperative metabolic outcomes.</p>