Complete Remission Of Diabetes Research Articles

Transcriptome Changes and Metabolic Outcomes After Bariatric Surgery in Adults With Obesity and Type 2 Diabetes.

Bariatric surgery has been shown to be effective in inducing complete remission of type 2 diabetes in adults with obesity. However, its efficacy in achieving complete diabetes remission remains variable and difficult to predict before surgery. We aimed to characterize bariatric surgery-induced transcriptome changes associated with diabetes remission and the predictive role of the baseline transcriptome. We performed a whole-genome microarray in peripheral mononuclear cells at baseline (before surgery) and 2 and 12 months after bariatric surgery in a prospective cohort of 26 adults with obesity and type 2 diabetes. We applied machine learning to the baseline transcriptome to identify genes that predict metabolic outcomes. We validated the microarray expression profile using a real-time polymerase chain reaction. Sixteen patients entered diabetes remission at 12 months and 10 did not. The gene-expression analysis showed similarities and differences between responders and nonresponders. The difference included the expression of critical genes (SKT4, SIRT1, and TNF superfamily), metabolic and signaling pathways (Hippo, Sirtuin, ARE-mediated messenger RNA degradation, MSP-RON, and Huntington), and predicted biological functions (β-cell growth and proliferation, insulin and glucose metabolism, energy balance, inflammation, and neurodegeneration). Modeling the baseline transcriptome identified 10 genes that could hypothetically predict the metabolic outcome before bariatric surgery. The changes in the transcriptome after bariatric surgery distinguish patients in whom diabetes enters complete remission from those who do not. The baseline transcriptome can contribute to the prediction of bariatric surgery-induced diabetes remission preoperatively.

Comparison of 1-year outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy with Roux-en-Y duodenojejunal bypass in the patients of obesity with type 2 diabetes mellitus

Objective: To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes. Methods: A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m2 were included in this study and divided into the RYGB group (n=34) and the SG+RYDJB group (n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results: There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m2 vs. 34.3±4.2 kg/m2, respectively; 24.3±2.4 kg/m2 vs. 32.7±3.7 kg/m2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions: Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.

Diabetes remission and relapse following an intensive metabolic intervention combining insulin glargine/lixisenatide, metformin and lifestyle approaches: Results of a randomised controlled trial.

Non-surgical options for inducing type 2 diabetes remission are limited. We examined whether remission can be achieved by combining lifestyle approaches and short-term intensive glucose-lowering therapy. In this trial, 160 patients with type 2 diabetes on none to two diabetes medications other than insulin were randomised to (a) an intervention comprising lifestyle approaches, insulin glargine/lixisenatide and metformin, or (b) standard care. Participants with glycated haemoglobin (HbA1c) <7.3% (56 mmol/mol) at 12 weeks were asked to stop diabetes medications and were followed for an additional 52 weeks. The primary outcome was diabetes relapse defined as HbA1c ≥6.5% (48 mmol/mol) at 24 weeks or thereafter, capillary glucose ≥10 mmol/L on ≥50% of readings, or use of diabetes medications, analysed as time-to-event. Main secondary outcomes included complete or partial diabetes remission at 24, 36, 48 and 64 weeks defined as HbA1c <6.5% (48 mmol/mol) off diabetes medications since 12 weeks after randomisation. A hierarchical testing strategy was applied. The intervention significantly reduced the hazard of diabetes relapse by 43% (adjusted hazard ratio 0.57, 95% confidence interval 0.40-0.81; p = .002). Complete or partial diabetes remission was achieved in 30 (38.0%) intervention group participants versus 16 (19.8%) controls at 24 weeks and 25 (31.6%) versus 14 (17.3%) at 36 weeks [relative risk 1.92 (95% confidence interval 1.14-3.24) and 1.83 (1.03-3.26), respectively]. The relative risk of diabetes remission in the intervention versus control group was 1.88 (1.00-3.53) at 48 weeks and 2.05 (0.98-4.29) at 64 weeks. A 12-week intensive intervention comprising insulin glargine/lixisenatide, metformin and lifestyle approaches can induce remission of diabetes.

685-P: Possibility of Oral Glucose Tolerance Test Clearance in Patients with Type 2 Diabetes Who Underwent Complete Diabetes Remission

Background and Aim­: Type 2 diabetes (T2D) remission through calorie and carbohydrate restriction has been reported. We conducted a pilot trial to observe whether oral Glucose tolerance test (OGTT) clearance is possible in T2D patients who underwent remission through a lifestyle modification program. Methods: A total of 3689 patients who had previously undergone remission through our lifestyle modification program at Freedom from Diabetes Clinic, India, were asked to enroll for the OGTT; 1121 accepted the invitation and enrolled (June 2022). Remission was defined as HbA1c&amp;lt;48mmol/mol for a minimum of three months without glucose-lowering medication. Of 1121, 400 participants completed a 3-month training (where foods with increasing glycemic load were introduced every week while monitoring the blood sugar levels (BSL)). Subsequently, they appeared for OGTT (75g) from October-November 2022. Results: Of the 400 participants, 207 (51.7%) cleared OGTT [Fasting BSL(FBSL)≤100, 2-hrs postprandial (PP2) &amp;lt;140], 175 (43.7%) cleared IGT-Impaired Glucose Tolerance (FBSL&amp;lt;126, PP2&amp;lt;200), while 18 (4.5%) did not clear. The median BMI at the time of appearing for OGTT was 22.8 kg/m2. Those clearing OGTT had significantly higher weight loss during the program than those clearing IGT (10 kg vs 6.4 kg) and had a shorter duration of diabetes (5 years vs 6.9 years) (p&amp;lt;0.05). Medication status at the start of the intervention (OHA, Insulin, both, and no medication) did not affect the possibility of clearing OGTT (p&amp;gt;0.1). Conclusion: Complete remission of type 2 diabetes to the point of achieving a nondiabetes glycemic profile irrespective of initial medication status is possible through lifestyle intervention if weight loss is achieved and maintained. The long-term sustainability of lifestyle interventions in achieving remission needs to be explored through a larger cohort study with a control group. Disclosure P. Tripathi: Board Member; Freedom from Diabetes Clinic. N.S. Kadam: Research Support; Freedom from Diabetes Clinic. A.R. Vyawahare: Research Support; Freedom From Diabetes. B. Sharma: Research Support; Freedom From Diabetes clinic. M.H. Ganla: Employee; Freedom from Diabetes Clinic. M. Das Biswas: Employee; Freedom from Diabetes Clinic. B.D. Saboo: None.

Complete remission of diabetes with a transient HDAC inhibitor and insulin in streptozotocin mice

Despite the growing epidemic worldwide, diabetes is an incurable disease. We have been focusing on why diabetes manifests refractoriness to any therapy. We recently found that abnormal bone marrow-derived cells (BMDCs), namely, Vcam-1+ST-HSCs, was a key mechanism for diabetic complications. We then hypothesize that those aberrant BMDCs sustainedly impair pancreatic β cells. Here we show that eliminating abnormal BMDCs using bone marrow transplantation results in controlling serum glucose in diabetic mice, in which normoglycemia is sustained even after cessation of insulin therapy. Alternatively, abnormal BMDCs exhibiting epigenetic alterations are treated with an HDAC inhibitor, givinostat, in diabetic mice. As a result, those mice are normoglycemic along with restored insulin secretion even following the cessation of both insulin and givinostat. Diabetic cell fusion between abnormal BMDCs and resident cells is significantly blocked by the combination therapy in the pancreatic islets and thymus while surgical ablation of the thymus completely eliminates therapeutic protection in diabetic mice. In conclusion, diabetes is an epigenetic stem cell disorder with thymic disturbances. The combination may be applied to patients aiming at complete remission from diabetes in clinical medicine.

Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta-analysis and network meta-analysis of randomized controlled trials.

To compare different types of metabolic surgery with non-surgical therapy for the treatment of type 2 diabetes (T2D). The present network meta-analysis (NMA) includes randomized clinical trials (duration ≥ 52 weeks) comparing different surgery techniques with non-surgical therapy in diabetes patients. The primary endpoints were endpoint HbA1c, body mass index (BMI) and diabetes remission. The secondary endpoints included fasting plasma glucose, lipid profile, blood pressure, arterial hypertension and dyslipidaemia remission, quality of life and surgical adverse events. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and the Mantel-Haenzel odds ratio for categorial variables, were calculated. The types of surgical procedure included laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD), greater curvature plication (GCP), one-anastomosis gastric bypass (OAGB) and Duodeno-Jejunal bypass. Thirty-six trials were included. Metabolic bariatric surgery (MBS) was associated with a significantly higher reduction of HbA1c, diabetes remission and BMI compared with medical therapy. In the NMA, a significant reduction of HbA1c was observed with OAGB and SG. Complete diabetes remission significantly increased with all surgical procedures in comparison with non-surgical therapy, except for GCP. In addition, only BPD, RYGB and OAGB were associated with a significant reduction of BMI. MBS is an effective option for the treatment of T2D in patients with obesity. Further long-term trials of appropriate quality are needed for assessing the risk-benefit ratio in some patient cohorts, such as those with a BMI of less than 35 kg/m2 and aged older than 65 years.

Recognizing the True Value of Testosterone Therapy in Health Care.

There has been little recognition within the medical community of the health impact of testosterone (T) deficiency (TD), also known as hypogonadism, and the substantial benefits of testosterone therapy (TTh) on health and quality of life despite high-level clinical evidence. In a roundtable symposium, investigators summarized the contemporary evidence in several key clinical areas. TD negatively impacts human health and quality of life and is associated with increased mortality. Several studies have demonstrated that TTh in men with TD reduced all-cause and cardiovascular mortality. The longstanding belief that TTh is associated with increased prostate cancer (PCa) risk is contradicted by recent evidence, including multiple studies showing that TTh is associated with reduced PCa risk. Similarly, the weight of current evidence indicates the purported concern that TTh is associated with increased cardiovascular risk is incorrect. Normalization of physiological T reduces myocardial infarction, stroke, and deaths compared with men whose testosterone levels failed to normalize. In diabetic men TTh improves insulin resistance, and a large 2-year controlled study in men with abnormal glucose tolerance showed a substantially reduced rate of diabetes among men treated with TTh compared with untreated controls. Long-term TTh in diabetic men resulted in progressive improvements in obesity and insulin requirements, including a substantial number who experienced complete remission of diabetes. Finally, TTh has been shown to reduce severe outcomes with Covid-19 infection. These lines of evidence argue strongly for the need for greater awareness in the medical community of the impact of TD on health, and of the health benefits of TTh.

Based on Propensity Matching Scores: Comparison of the Efficacy of Two Kinds of Bariatric Surgery for Obese Type 2 Diabetes.

To compare the efficacy of OADS and SG in treating obese T2D in China. We included 99 obese Chinese patients with T2D undergoing OADS or SG with a 1-year postoperative follow-up from January 2014 to October 2021. Using the propensity score matching (PSM) method, patients from both groups were matched 1:1. Outcomes for losing weight, controlling diabetes, and nutrition were then determined. There were 32 patients in each group after using the PSM method, and there was no statistically significant difference between the two groups in terms of all the baseline indicators (P > 0.05). When comparing weight loss outcomes, the OADS group outperformed the SG group in terms of change in BMI and %TWL, with statistically significant differences [15.0 (8.1-26.6) kg/m2, 10.0 (4.10-23.5) kg/m2 P = 0.001; 38.5% ± 6.7%, 29.5% ± 9.4%, P = 0.000]. When comparing the efficacy of diabetes, the OADS group outperformed the SG group in terms of HbA1C and complete remission of diabetes, with statistically significant differences [5.1 (3.8-5.6)%, 5.4 (4.3-7.9)%, P = 0.001; 100%, 75%, P = 0.005]. Besides, the incidence of postoperative zinc deficiency in the OADS group was significantly higher than in the SG group (P = 0.019) and there was no significant difference in other postoperative nutritional outcomes between the two groups. Although OADS and SG are both effective in the treatment of obese T2D, OADS performs better. Besides, the long-term efficacy of both needs to be recorded at subsequent follow-up.

Association of Baseline Triglyceride-Glucose Index with Poor Glycemic Control and Diabetes Remission After Metabolic Surgery.

The utility of insulin resistance (IR) as a predictor of diabetes remission after metabolic surgery is not well-defined. We assessed the association of baseline surrogate IR indices including triglyceride-glucose (TyG) index and homeostatic model assessment for IR (HOMA-IR) with glycemic control and diabetes remission after metabolic surgery. Patients with type 2 diabetes scheduled for metabolic surgery were recruited at a single-center (n = 149; age: 44 ± 10years, 47.7% men, body mass index: 41.5 ± 7.5kg/m2), and followed-up for 12months postoperatively. The relationships between the IR indices and poor glycemic control (HbA1c ≥ 7%) at baseline or complete diabetes remission (HbA1c < 6% without glucose-lowering medications at 12months) post-surgery were examined. Elevated TyG index was associated with poor glycemic control cross-sectionally. Compared with non-remitters, lower baseline TyG index levels were observed in individuals with complete diabetes remission after surgery (P = 0.012); whereas HOMA-IR was not significantly different. Consistently, the proportion of diabetes non-remitters (compared to remitters) increased with increasing TyG tertiles from 1 to 3 (P = 0.015). Both TyG index (relative risk = 0.62, 95% CI = 0.42-0.91, P = 0.014) and TyG tertile 1 (relative risk = 1.99, 95% CI = 1.25-3.24, P = 0.003) independently predicted diabetes remission. The TyG index identified diabetes remission with an area under the curve of 0.68. The optimal TyG threshold was 9.41, yielding a sensitivity of 69.6%, specificity of 60.9%, positive predictive value of 64.0%, and negative predictive value of 66.7%. TyG index, previously suggested to predominantly reflect muscle IR, outperforms HOMA-IR as an IR indicator associated with glycemic control and diabetes remission after metabolic surgery.

Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for type 2 diabetes remission (ORDER): protocol of a multicentre, randomised controlled, open-label, superiority trial

IntroductionPrevious studies have demonstrated that one anastomosis gastric bypass (OAGB) is not inferior to Roux-en-Y gastric bypass (RYGB) in treating obesity. However, high level evidence comparing the efficacy and safety...

Remission in Type 2 DM with Personalized Medical Interventions Including Life Style Modification and Appropriate Pharmacotherapy - A Case Report

Introduction: Increase in prevalence of type-2 diabetes in background of increased prevalence of obesity has increased overall health risk and complicates its management. Health benefits of weight loss and strategies for the same have been found to be effective. Caring for people living with diabetes and obesity requires a person-centred approach using the most appropriate evidence based individualized care. This case study discusses diabetes and weight management in a patient with sub-optimally controlled diabetes and a high BMI with potential for reversal of Diabetes. Clinical Problem: Extremely obese (BMI-43.23kg/m2) middle-aged person with hypertension and diabetes as comorbidity with sedentary lifestyle having sub-optimal glycaemic control (HbA1c 11.2%) with fatty liver disease presented for management of his sub-optimal glycaemic control. Management plan and its rationales with outcomes: Proper education about self-management of diabetes and counselling for importance of weight management and its long-term benefits were explained to patient. Low calorie diet with a calorie deficit of 600 calories per day, one-hour moderate intensity exercise day, SGLT-2i (dapagliflozin 10mg daily), Metformin 2000mg daily, GLP1RA (Liraglutide in incremental dose followed by switch over to oral similitude), Saroglitazar (dual PPAR agonist) along with antihypertensive medication and statin was started in this patient.At 4 months of intervention patient has tolerated the treatment very well and lost 26kg of body weight. His glycated HbA1c came down to 4.2% from 11.2%. Reversal of urine albumin to creatinine ratio to normal range was another significant change. Conclusion: Personalized medical interventions including lifestyle changes and appropriate antidiabetic medication was associated with&gt;25% weight loss, which can potentially induce complete remission of type-2 diabetes.

Comparison of the Long-term Outcomes of RYGB and OAGB as Conversion Procedures After Failed LSG — a Case–Control Study

ObjectiveTo compare the effect of RYGB and OAGB on patients after failed treatment of obesity by laparoscopic sleeve gastrectomy (LSG). Study DesignA case–control study based on a prospectively maintained database of reoperated patients after failed LSG, which included 33 patients who underwent RYGB conversion and 47 patients who underwent OAGB conversion. ResultThe mean %EBWL after a 5-year follow-up for RYGBc vs OAGBc was 84.04% vs 72.95% (p = 0.2176), respectively. Complete long-term diabetes remission was observed significantly more frequently in the OAGBc than in the RYGBc group (97.3% vs 33%; p = 0.035). There were no other statistically significant differences in the remission rate of comorbidities between RYGBc and OAGBc: hypertension 30% vs 27.3% (p = 0.261), dyslipidemia 83.3% vs 59.1% (p = 0.277), OSAS 100% vs 60% (p = 0.639), and GERD 40% vs 71.4% (p > 0.99), respectively. 7 patients were newly diagnosed with GERD after OAGBc and none after RYGBc. There were no statistically significant differences in the number of complications between the OAGBc and RYGB groups. The Comprehensive Complication Index was 17.85 (± IQR 29.6) in the OAGBc group and 14.92 (± IQR 21.75) in the RYGBc group (p = 0.375). ConclusionThe authors recognized complete long-term type 2 diabetes remission after conversion surgery as the most relevant difference, where the OAGB variety was found superior for its better efficacy. Any other statistically significant differences in the consequences after both conversion procedures used after the failure of LSG have not been stated. Both methods therefore can be considered to complete the initial treatment, considering the preferences and individual burdens of the patients.

Time impact on the antidiabetic effects of key bariatric surgeries:anetwork meta-analysis of randomized controlled trials with meta-regression.

Few studies compare the efficacy of the key bariatric procedures in type 2 diabetes management over the long term. None offer a reliable comparison of their respective efficacy loss over time. To analyze and compare the time evolution of the antidiabetic effects of the key bariatric procedures. Obesity surgery departments in America, Europe, and Asia. All the randomized clinical trials assessing the efficacy of bariatric surgery in type 2 diabetes management with 1-5 years of follow-up were reviewed. A network meta-analysis with meta-regression was performed to compare the effectiveness of each technique and its respective efficacy loss temporal dynamics. Thirty-one trials involving 1906 patients were included. In comparison to Roux-en-Y gastric bypass, the 5-year complete or partial diabetes remission rates were inferior with medical treatment (odds ratio [OR] = .05; 95% credible interval [CrI]: .02-.13) and gastric banding (OR= .38; 95% CrI: .16-.87), equivalent with sleeve gastrectomy (OR = 1.08; 95% CrI: .59-1.97), and superior with 1 anastomosis gastric bypass (OR = 3.00; 95% CrI: 1.12-8.33) and biliopancreatic diversion and its affiliated techniques (OR = 3.71; 95% CrI: 1.16-12.55). However, remission rates and glycemic control progressively decreased whatever the treatment option evaluated. Moreover, this loss of efficacy followed a statistically comparable temporal dynamic to those of Roux-en-Y gastric bypass regardless of the therapeutic strategy implemented. No therapeutic modality offered stable antidiabetic effects. The gap observed between the techniques after a 5-year follow up concerning remission rates and glycemic control could depend essentially on the magnitude of the effects initially obtained. However, these results need to be confirmed over longer follow-up periods.

Experience in biliopancreatic diversion with duodenal switch: Results at 2, 5 and 10 years

IntroductionDuodenal switch (DS) is considered one of the most effective techniques to achieve weight loss and reduce comorbidities in patients with morbidly obesity. Material and methodsDescriptive single-center study. 224 patients were analyzed who underwent direct laparoscopic DS in our center. The objective was to describe the results of weight, resolution of comorbidities, nutritional supplementation and postoperative complications at 2, 5 and 10 years. ResultsThe mean age of the cohort was 49.3 [23−65] years and the mean weight and BMI were 131.8 [20] kg and 49.8 [5] kg/m2. The excess weight lost percentage at 2, 5 and 10 years was 80.6[15]%, 69.3[18]%, 67.4[18]%, respectively. Complete remission of diabetes was evidenced at 2 and 5 years in 35 (85.4%) and 27 (70.4%) patients. In the immediate postoperative period, the complication rate for Clavien-Dindo ≥ III was 15 patients (6.7%) and mortality at 30 and 90 days was 1 (0.4%) and 2 (0.9%) patients. Revisional surgery was performed in 2 patients (0.9%). 80% of the patients required an extra nutritional supplement up to 10 years after surgery. ConclusionsDirect DS is a safe and effective technique in patients with a BMI between 45 and 55 kg/m2. Weight loss is maintained with a low rate of revision surgery. It is a metabolically effective technique that entails the need for a close postoperative follow-up to assess nutritional supplementation

Factors affecting relapse of type 2 diabetes after bariatric surgery in Sweden 2007-2015: a registry-based cohort study.

Although a large proportion of patients with type 2 diabetes (T2DM) who have undergone metabolic surgery experience initial remission some patients later suffer from relapse. While several factors associated with T2D remission are known, less is known about factors that may influence relapse. To identify possible risk factors for T2D relapse in patients who initially experienced remission. Nationwide, registry-based study. We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and body mass index ≥35 kg/m2 who received primary metabolic surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication. In total, 2090 patients in complete remission at 2 years after surgery were followed for a median of 5.9 years (interquartile range [IQR] 4.3-7.2 years) after surgery. The cumulative T2D relapse rate was 20.1%. Duration of diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.05-1.14; P < .001), preoperative glycosylated hemoglobin A1C (HbA1C) level (HR, 1.01; 95% CI, 1.00-1.02; P = .013), and preoperative insulin treatment (HR, 2.67; 95% CI, 1.84-3.90; P < .001) were associated with higher rates for relapse, while postoperative weight loss (HR, .93; 95% CI, .91-.96; P < .001), and male sex (HR, .65; 95% CI, .46-.91; P = .012) were associated with lower rates. Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.

Abstract #1088834: Health Economic Analysis of Digital Twin Technology for Remission of Diabetes - Initial Insights From the Prospective Randomised Controlled Clinical Trial

We performed an initial analysis for health economic impact of ongoing randomized controlled trial of Twin Precision Treatment, a novel whole-body digital twin enabled precision nutrition for reversing diabetes. We evaluated patients (n=33) who completed 4 months longitudinal follow up and modeled the parameters for the health economics from the published literature to benchmark with our results. Mean age, duration of diabetes was 40 (±8.8) and 2.8 (±2.4) years, respectively. 19 and 13 patients achieved initial partial (HbA1c range 5.7-6.4 %) and complete (HbA1c < 5.7%) remission of diabetes, respectively. All patients achieved HbA1c less than 7%. All 12 patients on OAD did not need ongoing OAD, 2 patients on insulin did not need it at 90 days. There was a statistically significant improvement in HbA1c % (8.7 ± 1.5 to 5.6 ± 0.51; decrease -3.1, p< 0.0001), body weight (79 ± 12 to 70 ± 11; decrease -9.1 kg, p=0.0014), BMI (28 ± 3.3 to 24 ± 2.9; decrease -3.4 kg/m2, p< 0.0001), Systolic BP (131 ± 13 to 119 ± 12; decrease -12 mmHg, p=0.0002), Diastolic BP (89 ± 11 to 79 ± 8; decrease -10 mmHg, p< 0.0001), HDL-C (33 ± 5.1 to 37 ± 8.2; increase 4.1 mg/dl, p=0.0191), TG (224 ± 99 to 130 ± 93; decrease -94 mg/dl, p< 0.0001). The modeled adjusted health cost savings entail a cumulative annual per patient savings of USD 7800 attributed to the improvement in BMI, HbA1c and blood pressure control. The results indicate that an efficacious early technological intervention, through digital twin technology, powered by Internet of Things and Artificial Intelligence, as a modality to enable reversal of diabetes. We postulate that the substantial cost savings and propensity for decrease in medical claim induced by the Twin Precision Treatment deserves a larger exploration by the health care payers.

Impact of the different biliopancreatic limb length on diabetes and incretin hormone secretion following distal gastrectomy in gastric cancer patients

The present study aimed to investigate changes in glucose metabolism and incretin hormone response following longer intestinal bypass reconstruction after distal gastrectomy (DG) in low BMI patients with gastric cancer and type 2 diabetes. A total of 20 patients were prospectively recruited and underwent either conventional Billroth I (BI), Billroth II with long-biliopancreatic limb (BII), or Roux-en-Y anastomosis with long-Roux limb (RY) after DG. A 75g-oral glucose tolerance test (OGTT) was given preoperatively; and at 5 days, 3 months, and 6 months postoperatively. Serum glucose, insulin, glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were serially measured. At 6 months after surgery, complete diabetes remission was achieved in 57.1% of the BII group but in no patients in the other two groups (p = 0.018). BII group showed a significant reduction in glucose concentration during OGTT at 6 months in contrast to the other 2 groups. In the BII group, a significant increase in GLP-1 secretion was observed after surgery but not maintained at 6 months, while postoperative hyperglucagonemia was alleviated along with a reduction in GIP. BII gastrojejunostomy with long biliopancreatic limb achieved better diabetes control with favorable incretin response after DG compared to BI or RY reconstruction.

Abstract 12530: Impact of Multiple Lifestyle Intervention on Body Weight, Insulin Sensitivity and Remission of Type 2 Diabetes: A Single-Center Experience

Introduction: Type 2 diabetes (T2D) and pre-diabetes are mostly lifestyle diseases associated with high rates of morbidity, mortality, and health care expenditures. Hypothesis: The Montreal Heart Institute Cardiovascular Prevention EPIC Center started a comprehensive lifestyle clinic for patients with T2D in 2019. We sought to study the impacts of a 12-month non-pharmacological intervention on body weight, insulin sensitivity and remission of T2D. Methods: Between January and December 2019, 105 with T2D (HbA1c ≥ 6.5%) were recruited. Anthropometric measures and fasting blood analysis were measured at 0,3,6 and 12 months. All patients received regular nutritional counselling and personalized physical exercise prescription. Glucose-lowering therapies were not modified, unless necessary. Partial and complete remission of diabetes were defined by HbA1c &lt;6.5% and HbA1c &lt;5.7% respectively, for at least 3 months. Differences in means across variables with repeated observations were assessed with ANOVA. Factors associated with obtaining partial remission at 3 months were analyzed using a multivariate logistic model. Results: 96 patients completed the intervention (91%), mean age was 67.5±10.5 years, 72% male, 37% with coronary heart disease, 23% without glucose-lowering therapies. Mean baseline HbA1c was 7.3±0.8 %. At program end, all anthropometric and insulin resistance measures were significantly improved (Table 1); HbA1c -0.78 (95CI: -0.57 à -0.98, p&lt;0.001). Gains were achieved at 3 months and were maintained during the program without significant change. Partial remission was achieved in 56.1% (95CI: 45.1 to 66.5%) and complete remission of diabetes was attained in 11% (95CI: 5.7 to 19.9%) of participants. Adjusted by age, sex, treatment, baselineHbA1c and weight loss at 3 months; individuals with low HbA1c (p=0.01) and those that lost &gt;3.5Kg at 3 months (OR 4.1, 95%CI: 1.5 to 11.1, p=0.005) were significantly more likely to attain partial remission. Conclusions: Prioritizing lifestyle changes were shown to improve anthropometric and insulin resistance measures even to the point of normalizing some metabolic values among subjects with T2D. These changes were mostly achieved after 3 months and were maintained throughout the intervention.

IMPACT OF MULTIPLE LIFESTYLE INTERVENTION ON BODY WEIGHT, INSULIN SENSITIVITY AND REMISSION OF TYPE 2 DIABETES: A SINGLE-CENTER EXPERIENCE

BACKGROUND Type 2 diabetes (T2D) and pre-diabetes are mostly lifestyle diseases associated with high rates of morbidity, mortality, and health care expenditures. Different intensive lifestyle interventions have shown to be useful for effective control and even reverse these conditions. However, these strategies are rarely implemented as first-line choices. Objectives The Montréal Heart Institute Cardiovascular Prevention Center (EPIC) started a comprehensive lifestyle clinic for patients with T2D in 2019. We sought to study the impacts of a 12-month non-pharmacological intervention on body weight, insulin sensitivity and remission of T2D. METHODS AND RESULTS Between January and December 2019, 105 diabetic patients (HbA1c ≥ 6.5%) were recruited. Anthropometric measures and fasting blood analysis were measured at 0-3-6 and 12 months. All patients received regular nutritional counselling (therapeutic moderate carbohydrate restriction Mediterranean diet) and personalized physical exercise prescription (≥30 minutes of moderate aerobic training, 5 times a week, and strength training). Glucose-lowering therapies, if taken, were not modified unless necessary. Partial and complete remission of diabetes were defined by HbA1c < 6.5% and HbA1c < 5.7% respectively, for at least 3 months. Differences in means across variables with repeated observations were assessed with ANOVA. Factors associated with obtaining partial remission at 3 months were analyzed using a multivariate logistic model. 96 patients completed the intervention (91%), mean age was 67.5 (SD=10.5) years, 72% male, 37% with CHD, 23% without glucose-lowering therapies. Mean initial HbA1c was 7.3% (SD=0.8). At program end, all anthropometric and insulin resistance measures were significantly improved (Table 1); HbA1c -0.78 (95CI: -0.57 à -0.98, p < 0.001). Gains were achieved at 3 months and were maintained during the program without significant change. Partial remission was achieved in 56.1% (95CI: 45.1 to 66.5%) and complete remission of diabetes was attained in 11% (95CI: 5.7 to 19.9%) of participants. Among patients without glucose-lowering therapies (n=22), 73.7% (95CI: 48.4 to 51.6%) and 10.5% (95CI: 2.4 to 36.1%) attained partial and complete remission respectively. Adjusted by age, sex, treatment, basal HbA1c and weight loss at 3 months; individuals with low HbA1c (p=0.01) and those that lost >3.5Kg at 3 months (OR 4.1, 95%CI: 1.5 to 11.1, p=0.005) were significantly more likely to attain partial remission. CONCLUSION Prioritizing lifestyle changes were shown to improve anthropometric and insulin resistance measures even to the point of normalizing some metabolic values among subjects with T2D. These changes were mostly achieved after 3 months and were maintained throughout the intervention. Type 2 diabetes (T2D) and pre-diabetes are mostly lifestyle diseases associated with high rates of morbidity, mortality, and health care expenditures. Different intensive lifestyle interventions have shown to be useful for effective control and even reverse these conditions. However, these strategies are rarely implemented as first-line choices. Objectives The Montréal Heart Institute Cardiovascular Prevention Center (EPIC) started a comprehensive lifestyle clinic for patients with T2D in 2019. We sought to study the impacts of a 12-month non-pharmacological intervention on body weight, insulin sensitivity and remission of T2D. Between January and December 2019, 105 diabetic patients (HbA1c ≥ 6.5%) were recruited. Anthropometric measures and fasting blood analysis were measured at 0-3-6 and 12 months. All patients received regular nutritional counselling (therapeutic moderate carbohydrate restriction Mediterranean diet) and personalized physical exercise prescription (≥30 minutes of moderate aerobic training, 5 times a week, and strength training). Glucose-lowering therapies, if taken, were not modified unless necessary. Partial and complete remission of diabetes were defined by HbA1c < 6.5% and HbA1c < 5.7% respectively, for at least 3 months. Differences in means across variables with repeated observations were assessed with ANOVA. Factors associated with obtaining partial remission at 3 months were analyzed using a multivariate logistic model. 96 patients completed the intervention (91%), mean age was 67.5 (SD=10.5) years, 72% male, 37% with CHD, 23% without glucose-lowering therapies. Mean initial HbA1c was 7.3% (SD=0.8). At program end, all anthropometric and insulin resistance measures were significantly improved (Table 1); HbA1c -0.78 (95CI: -0.57 à -0.98, p < 0.001). Gains were achieved at 3 months and were maintained during the program without significant change. Partial remission was achieved in 56.1% (95CI: 45.1 to 66.5%) and complete remission of diabetes was attained in 11% (95CI: 5.7 to 19.9%) of participants. Among patients without glucose-lowering therapies (n=22), 73.7% (95CI: 48.4 to 51.6%) and 10.5% (95CI: 2.4 to 36.1%) attained partial and complete remission respectively. Adjusted by age, sex, treatment, basal HbA1c and weight loss at 3 months; individuals with low HbA1c (p=0.01) and those that lost >3.5Kg at 3 months (OR 4.1, 95%CI: 1.5 to 11.1, p=0.005) were significantly more likely to attain partial remission. Prioritizing lifestyle changes were shown to improve anthropometric and insulin resistance measures even to the point of normalizing some metabolic values among subjects with T2D. These changes were mostly achieved after 3 months and were maintained throughout the intervention.

External validation of predictive scores for diabetes remission after metabolic surgery

PurposeBariatric surgery has proven to be the most efficient treatment for obesity and type 2 diabetes mellitus (T2DM). Despite detailed qualification, desirable outcome after an intervention is not achieved by every patient. Various risk prediction models of diabetes remission after metabolic surgery have been established to facilitate the decision-making process. The purpose of the study is to validate the performance of available risk prediction scores for diabetes remission a year after surgical treatment and to determine the optimal model.MethodsA retrospective analysis comprised 252 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2009 and 2017 and completed 1-year follow-up. The literature review revealed 5 models, which were subsequently explored in our study. Each score relationship with diabetes remission was assessed using logistic regression. Discrimination was evaluated by area under the receiver operating characteristic (AUROC) curve, whereas calibration by the Hosmer–Lemeshow test and predicted versus observed remission ratio.ResultsOne year after surgery, 68.7% partial and 21.8% complete diabetes remission and 53.4% excessive weight loss were observed. DiaBetter demonstrated the best predictive performance (AUROC 0.81; 95% confidence interval (CI) 0.71–0.90; p-value > 0.05 in the Hosmer–Lemeshow test; predicted-to-observed ratio 1.09). The majority of models showed acceptable discrimination power. In calibration, only the DiaBetter score did not lose goodness-of-fit in all analyzed groups.ConclusionThe DiaBetter score seems to be the most appropriate tool to predict diabetes remission after metabolic surgery since it presents adequate accuracy and is convenient to use in clinical practice. There are no accurate models to predict T2DM remission in a patient with advanced diabetes.