Diabetes Remission In Patients Research Articles

Association between previous consumption of sugar-sweetened beverages and diabetes remission in patients with newly diagnosed type 2 diabetic ketoacidosis.

This study examined the potential correlation between the immoderate intake of sugar-sweetened beverages (SSBs) and the subsequent rate of diabetes remission (DR). 206 individuals who met the eligibility criteria between January 2019 and June 2022 were recruited. Inquiries were conducted to gather information on the participants' beverage consumption before the onset. Subsequently, the participants were separated into the diabetes remission group (DR group) and nondiabetes remission group (NDR group) depending on whether they met the diagnostic criteria for diabetes remission. Baseline clinical elements within the two groups were juxtaposed, and factors influencing diabetes remission were identified through logistic regression analyses. The cutoff values of each critical factor were determined based on the receiver operating characteristic curve. One hundred and nine patients reported a history of SSB consumption, while the remaining 58 reported no such history. After 1 year, 40 patients achieved remission from diabetes. Compared with the NDR group, a higher SSBs ratio, body mass index (BMI), and blood creatinine (BCr) was observed in the DR group after adjusting for confounders, SSBs (odds ratio [OR] = 3.503; 95% confidence interval [CI] = 1.334-9.202; p = 0.011) and BCr (OR = 1.038; 95% CI = 1.003-1.079; p = 0.042) emerged as independent predictors of DR. The composite index of SSBs and BCr efficaciously predicted DR (area under the ROC curve [AUC] = 0.810, p < 0.001). SSBs and BCr were independent risk factors for DR. The amalgamation of these markers could more accurately predict DR.

Type 2 Diabetes Remission in Patients with Heterozygous Variants in the Leptin-Melanocortin Pathway after Roux-en-Y Gastric Bypass: A Matched Case-Control Study.

Roux-en-Y gastric bypass (RYGB) is associated with a high rate of type 2 diabetes (T2D) remission. Carriers of heterozygous variants in the leptin-melanocortin pathway (LMP) are more likely to experience weight recurrence after RYGB. Our aim was to investigate if carrier status and associated weight regain affects the rate of T2D remission after RYGB. Carriers of LMP variants with a diagnosis of T2D prior to RYGB (N = 16) were matched to non-carriers (N = 32) based on sex, age,and BMI. We assessed for post-operative T2D remission status post-surgery on a yearly basis, for up to 15years. Our primary endpoint was the proportion of patients achieving T2D remission at 1year. We conducted a survival analysis for all patients that achieved remission at least at one time-point to evaluate for maintenance of T2D remission by using a log-rank test. Both carriers and non-carriers had similar baseline and procedural characteristics. The proopiomelanocortin gene in the LMP pathway had the most variants (n = 5, 31%). Carriers had a lower total body weight loss percentage at nadir (28.7% ± 6.9) than non-carriers (33.7% ± 8.8, p = 0.04). The proportion of patients achieving T2D remission at 1year was 68.8% for carriers and 71.9% for non-carriers (p = 1.0). Survival curves for maintenance of first remission were similar for both groups (p = 0.73), with a median survival of 8years for both carriers and non-carriers. Despite inferior weight loss outcomes at nadir, carriers had similar T2D remission rates when compared to non-carriers. Weight-independent metabolic benefits of RYGB might contribute to this observation.

622-P: Characteristics of Diabetes Remission in Patients with Type 2 Diabetes

Background: Lifestyle intervention in achieving Type 2 diabetes (T2D) remission is gaining increasing significance. We aimed to identify predictors of diabetes remission after a one-year lifestyle intervention program in the Indian population. Materials and methods: The current study enrolled 4948 patients with diagnosed T2D (&amp;gt;18 years) who underwent a lifestyle modification program at Freedom from Diabetes clinic between April &amp; December 2021. The intervention included a customized vegan diet, exercise, stress management support, along with conventional medical management. Anthropometric and biochemical parameters were monitored with scheduled consultations every 3 months. Post-intervention remission was defined as HbA1c&amp;lt;48mmol/mol for a minimum of 3 months in the absence of pharmacotherapy. The primary outcome measure was predictors of diabetes remission based on regression analysis. Results: Post-intervention, data on 2764 patients were available for analysis where 837 (30.2%) achieved remission. Remission was significantly associated with intermittent fasting (during intervention), initial medication status (OHA, external insulin, both or never started medicines), age at onset, absolute change in HbA1c &amp; body weight, HOMA-IR (post-intervention), and duration of diabetes. Conclusion: T2D remission can be achieved in nearly one-third of the patients through lifestyle intervention. Few baseline (age at onset, duration of diabetes, medication status) and few post-intervention parameters (decrease in weight and HbA1c, HOMA-IR) are independently associated with predicting T2D remission in this Indian population. 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.

733-P: Diabetes Remission Outcomes Protocol (DROP)—Early Observation

A 12-week multidisciplinary intensive lifestyle intervention (ILI) was shown to induce diabetes remission (A1C &amp;lt;6.5%, on no medications for ≥3 months), particularly among participants with short diabetes duration. Diabetes remission was also achieved with very low-calorie diet (VLCD) or bariatric surgery. Diabetes Remission Outcomes Protocol (DROP) at Joslin Diabetes Center is an ILI designed to induce diabetes remission in patients with type 2 diabetes who meet 3 criteria: 1- duration of diabetes &amp;lt;5 years, 2- A1C &amp;lt;8%, 3- On up to 2 antihyperglycemic medications, but no insulin. It involves two phases: an intervention phase for 12 weeks and a maintenance phase for 9 months. During intervention phase, participants follow a time-restricted fasting for 16 hours and VLCD (800-1000 Kcal/day). Participants also receive cognitive behavioral support and perform exercises designed to maintain lean muscle mass (LMM). They stop all diabetes medications at the beginning of the program and are monitored by CGM. Reintroduction of medications is suggested if glucose time in range (70-180 mg/dL) (TIR) drops to &amp;lt;70%. During maintenance phase, participants return to 1500-1800 calorie diet with the aim of maintaining weight loss and diabetes remission. We tested feasibility of DROP in a pilot of 5 participants with mean age of 52.8±11.4 years, diabetes duration of 13.2±11.8 months, and A1C of 6.44±0.3% on 2 medications. By the end 12-weeks, average weight loss was 19.9 lbs (8.1%). A1C decreased to 6.14±0.48% (p=0.02) on no medications and TIR was 98%. LMM /total body weight significantly increased by 0.03±0.02 (p=0.03). Patient-reported quality of life measures showed significant improvements in the World Health Organization-5 Well-Being Index (p=0.03), Diabetes Distress Scale-17 (p=0.05) and 36-Item Short Form Survey (p=0.04) submodules. DROP is promising approach to induce diabetes remission and improve patients’ quality of life in selected patients with type 2 diabetes. Larger cohorts should be evaluated for longer duration. Disclosure K.Kibaa: None. A.Khater: None. R.Mccarragher: None. O.Hamdy: Advisory Panel; Abbott Nutrition, Nemaura Medical, L-Nutra Inc., Twin Health, Consultant; Sanofi, Research Support; Novo Nordisk, Eli Lilly and Company, Gilead Sciences, Inc., Stock/Shareholder; Healthimation. S.E.Dhaver: None. C.Johnson: None. J.L.Votta: None. J.I.Shahar: None. C.Mitchell: None. J.M.Beaton: None. T.Salah: None. M.Al-badri: None.

Predictors of T2DM Remission after Bariatric Surgery in Patients with a BMI < 35kg/m2: a Meta-Analysis.

Although a few studies have reported the predictors of postoperative diabetes remission in patients with body mass index (BMI) < 35kg/m2, the conclusions are still inconsistent. This meta-analysis aimed to evaluate the preoperative clinical factors of type 2 diabetes mellitus (T2DM) remission after bariatric surgery. The PubMed, Embase, and Cochrane Library databases were systematically searched until April 2022. The Newcastle-Ottawa Scale was used for quality assessment. Statistical heterogeneity was assessed with the I2 statistic, followed by subgroup and sensitivity analyses. 16 studies involving 932 patients were selected. T2DM remission was negatively correlated with age, duration, insulin use, fasting plasma glucose, fasting insulin, and glycosylated hemoglobin levels. While BMI, body weight, waist circumference, and C-peptide levels were positive predictors of T2DM remission in patients with a BMI < 35kg/m2. However, there was no significant association between gender, oral hypoglycemic agent, homeostasis model assessment, high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, and remission rate. Patients with younger age, short diabetes duration, more obesity, better glucose control, and better β cell function were more likely to achieve T2DM remission in patients with a BMI < 35kg/m2 after bariatric surgery.

Evaluating the role of time in range as a glycemic target during short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes.

Tight glycemic control during short-term intensive insulin therapy (SIIT) is critical for inducing diabetes remission in patients with newly diagnosed type 2 diabetes (T2D). This work aimed to investigate the role of time in range (TIR) during SIIT as a novel glycemic target by predicting clinical outcomes. SIIT was given to 116 patients with newly diagnosed T2D, with daily eight-point capillary glucose monitored. Glycemic targets (fasting/premeal glucose, 3.9-6.0 mmol/L; 2h postprandial blood glucose, 3.9-7.8 mmol/L) were achieved and maintained for 2 weeks. TIRPIR was calculated as the percentage of glucose points within these glycemic targets during the maintenance period and was compared to TIR3.9-7.8mmol/L and TIR3.9-10.0mmol/L . Acute insulin response (AIR), HOMA-IR, HOMA-B, and disposition index (DI) were measured. Patients were followed up for 1 year to observe clinical outcomes. TIRPIR , TIR3.9-7.8mmol/L , and TIR3.9-10.0mmol/L were 67.2 ± 11.2%, 80.8 ± 9.2%, and 90.1 ± 6.2%, respectively. After SIIT, β-cell function and insulin sensitivity improved remarkably, and the 1-year remission rate was 55.2%. △AIR and △DI were positively correlated with all the TIR values, whereas only TIRPIR was correlated with △HOMA-IR (r=-0.22, p=0.03). Higher TIRPIR but not TIR3.9-7.8mmol/L or TIR3.9-10.0mmol/L was robustly associated with diabetes remission; patients in the lower TIRPIR tertile had an elevated risk of hyperglycemia relapse (hazard ratio 3.4, 95% confidence interval 1.6-7.2， p=.001). Only those with TIRPIR ≥ 65% had a one-year remission rate of over 60%. These findings advocate TIRPIR ≥ 65% as a novel glycemic target during SIIT for clinical decision-making.

Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom.

Clinical trials have shown that bariatric surgery (BS) is associated with better glycemic control and diabetes remission in patients with type 2 diabetes (T2D) compared with routine care. We conducted a real-world population-based study examining the impact of BS on glycemic control and medications in patients with T2D. This was a retrospective, matched, controlled cohort study conducted between January 1, 1990, and January 31, 2018, using IQVIA Medical Research Data, a primary care electronic records database. Adults with body mass index (BMI) ≥30 kg/m2 and T2D who had BS (surgical) were matched for age, sex, BMI, and diabetes duration to two controls (with T2D and no BS). A total of 1126 patients in the surgical group and 2219 patients in the control group were analyzed. Mean (standard deviation) age was 50.0 (9.3) years, 67.6% were women, baseline glycocylated hemoglobin (HbA1C) was 7.8% (1.7 mmol/mol), and diabetes duration was 4.7 years (range, 2.0-8.4 years). Over a median (interquartile range) follow-up of 3.6 years (1.7-5.9 years), a higher proportion of patients in the surgical group achieved an HbA1C of ≤6.0% than the control group (65.8% versus 22.8%). The surgical group showed a decrease in mean HbA1C of 1.5% (95% confidence interval [CI]: 1.4%-1.7%), 1.4% (1.2%-1.5%), and 1.3% (1.1%-1.5%) at 1-, 2-, and 3-year follow-up, respectively, whereas HbA1C increased in the control group. The proportion of patients receiving glucose-lowering medications decreased in the surgical group (92.2% to 66.5%) but increased in the control group (85.3% to 90.2%). BS is associated with significant improvement in glycemic control, achievement ofnormal HbA1C levels, and reduced need for glucose-lowering therapy in patients with T2D.

Reduction in Circulating Advanced Glycation End Products by Mediterranean Diet Is Associated with Increased Likelihood of Type 2 Diabetes Remission in Patients with Coronary Heart Disease: From the Cordioprev Study.

It is hypothesized that decreased advanced glycation end products (AGEs) levels could affect type 2 diabetes mellitus (T2DM) remission in newly diagnosed patients through the consumption of two healthy diets. Patients from CORDIOPREV study, all with previous cardiovascular events, with T2DM at the beginning of the study are included. Patients are randomized to a Mediterranean or a low-fat diet for five years. No different diabetes remission rates are found among diets. Serum methylglioxal (MG) and carboximethyllysine (CML), levels dietary AGE, as well as gene expression of AGER1 and RAGE are measured. Serum MG decreases only after the consumption of the Mediterranean diet. Moreover, a COX regression analysis shows that each SD decrease in the MG, occurring after the Mediterranean diet, increases the probability of T2DM remission with HR:2.56(1.02-6.25) and p = 0.046 and each SD increase in disposition index at baseline increases the probability of remission with HR:1.94(1.32-2.87) and p = 0.001. It is demonstrated that the reduction of serum AGEs levels and the modulation of its metabolism, occurring after the consumption of a Mediterranean diet, might be involved in the molecular mechanism underlying the T2DM remission of newly diagnosed patients with coronary heart disease.

Insulin resistance in bariatric surgery.

To give an updated review on the underlying mechanisms and clinical effects of improved glucose control after bariatric surgery. The basic principles of the mechanism for the metabolic effects of bariatric surgery can be categorized into calorie restriction, deviation of nutrients, and reduced amounts of adipose tissue. Recent findings suggest the importance of early changes following deviation of nutrients to more distal parts of the small bowel resulting in altered release of gastrointestinal hormones, altered gut microbiota, and weight-reduction. In the long-term, loss of adipose tissue results in reduced inflammation and improved insulin sensitivity. From a clinical perspective these changes are associated with remission of diabetes in patients with morbid obesity and type 2 diabetes, prevention of diabetes in patients with insulin resistance without overt type 2 diabetes and prevention of both microvascular and macrovascular complications for all patients with morbid obesity. At present, bariatric surgery remains the most effective treatment option to improve glucose control and long-term complications associated with hyperglycemia in patients with obesity.Although the mechanisms behind these metabolic effects remain only partially understood, further knowledge on these complex mechanisms may help identifying durable treatment options for morbid obesity and important metabolic comorbidities.

A222 5 Year Follow-up of Previously Published Cohort Comparing Diabetes Surgery vs. Intensive Medical Weight Management on Diabetes Remission in Patients with Type 2 Diabetes and BMI 30-35; the Role of sRAGE Diabetes Marker as Potential Predictor of Success

A222 5 Year Follow-up of Previously Published Cohort Comparing Diabetes Surgery vs. Intensive Medical Weight Management on Diabetes Remission in Patients with Type 2 Diabetes and BMI 30-35; the Role of sRAGE Diabetes Marker as Potential Predictor of Success

A167 - DiaREM scores predict diabetes remission after bariatric surgery

Background: Bariatric surgery has been proven to be highly effective in controlling diabetes. However, not all patients who undergo the procedure achieve diabetes remission. The DiaREM score has been used to predict diabetes remission in patients with RYGB, but there are no studies that show its performance amongst the other bariatric surgery procedures.

A5149 - Evaluation of Diabetes Remission in Patients Undergoing Jejuno-Ileal Bypass with Internal Fistula in Juarez, MX

Jejuno-ileal bypass (JIB) was the first surgical technique (1954) to treat severe obesity. Due to complications (liver disease, pseudo-obstruction, malabsorption, etc) JIB was largely abandoned. A modified JIB with an internal fistula (JIB-IF) to avoid malabsorption complications was developed for treatment of Type 2 diabetes (T2D). The excluded bowel of JIB was attached via fistula to the upper jejunum, decreasing overall malabsorption, but allowing nutrients to reach the lower ileum and stimulate several gut hormones. An anterior plication close to the bypass anastomosis avoids reflux into the closed loop.

Preoperative Fasting Plasma C-Peptide Levels as Predictors of Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: A Systematic Review and Meta-Analysis

ABSTRACTAims: The study evaluated the predictive role of preoperative fasting C-peptide, hemoglobin (Hb)A1c, fasting plasma glucose (FPG), and body mass index (BMI) levels on diabetes remission in patients with type 2 diabetes following bariatric surgery. Methods: Medline, PubMed, Central, and Google Scholar databases of up to September 7, 2016 were searched using the following terms: type 2 diabetes mellitus, gastric bypass, Roux-en-Y, anastomosis, C-peptide, weight loss, HbA/HbA1c, predictive/predictor. Results: Meta-analysis of the pooled data indicated that fasting C-peptide was predictive of increased chance of remission of type 2 diabetes (pooled difference in means = 0.93, 95% confidence interval [CI] = 0.61 to 1.25, p < .001). The analysis also found that FPG (pooled standardized mean difference = −0.42, 95% CI: −0.64 to −0.20, p < .004) and HbA1c levels (pooled difference in means = −1.05, 95% CI: −1.48 to −0.62, p < .001) were associated with reduced odds of type 2 diabetes remission. BMI was not found to be associated with remission (pooled difference in means = 0.29, 95% CI: 0.30 to 0.88, p = .343). In general, subgroup analysis, which evaluated the pooled data from the retrospective and prospective studies separately, gave similar results. Conclusions: Preoperative fasting plasma C-peptide was associated with increased type 2 diabetes remission after bariatric surgery, whereas baseline HbA1c and FPG levels were associated with reduced chance of remission. These parameters may be used as a guideline in weighing the risks and benefits for surgical intervention in patients with type 2 diabetes.

Effect of Bariatric Surgery vs Medical Treatment on Type 2 Diabetes in Patients With Body Mass Index Lower Than 35: Five-Year Outcomes.

It has been well recognized that metabolic surgery has short-term benefits for mildly obese patients with type 2 diabetes mellitus (T2DM), but how long these effects can be sustained is uncertain. To compare the 5-year efficacy between gastrointestinal metabolic surgery and medical treatment on glycemic control and diabetes remission in patients with T2DM and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) lower than 35. This retrospective cohort study compares long-term outcomes for mildly obese patients with T2DM receiving metabolic surgery (n = 52) vs medical treatment (n = 299). The surgical group, enrolled from August 20, 2007, to June 25, 2008, and followed up through December 31, 2013, received standard sleeve gastrectomy (n = 19) or bypass (n = 33) procedures in a regional hospital. The medical group, selected from a nationwide community cohort that was recruited from August 27, 2003, to December 31, 2005, and followed up through December 31, 2012, was matched with the surgical group by age, BMI, and diabetes duration. Glycated hemoglobin (HbA1c) reduction and prolonged complete and partial diabetes remission (defined as HbA1c <6.0% and 6.0%-6.5% of total hemoglobin [Hb; to convert to proportion of total Hb, multiply by 0.01], respectively, for those who were exempted from any antidiabetic drugs for 5 years). At the end of the fifth year, the surgical group had a mean weight loss of 21.0% (from a mean [SD] BMI of 31.0 [2.4] to 24.5 [2.7]), their mean (SD) HbA1c decreased from 9.1% (2.1%) to 6.3% (1.1%) of total Hb, 18 participants (36.0%) had complete remission, 14 (28.0%) had partial remission, 1 (1.9%) died, and 1 (1.9%) had end-stage renal disease. In the same follow-up period in the medical group, 3 (1.2%) had complete remission, 4 (1.6%) had partial remission, 9 (3.0%) died, and 2 (0.7%) had end-stage renal disease; their mean HbA1c remained around 8% of total Hb (mean [SD], 8.1% [1.8%] of total Hb at baseline and 8.0% [1.6%] of total Hb at 5 years), and BMI also stayed similar (mean [SD], 29.1 [2.4] at baseline and 28.8 [2.6] at 5 years). The HbA1c reduction and complete and partial remission rates were all significantly larger in the surgical group as compared with the medical group (all P < .001). However, the mortality rate and end-stage renal disease incidence were not significantly different in these 2 comparison groups (P = .66 and .37, respectively). For mildly obese patients with T2DM, the improvement in glycemic control from metabolic surgery lasts at least 5 years. However, the survival benefit and lifelong adverse outcomes require more than 5 years to be established.

A125 - Long-Term Follow-Up of Pilot Randomized Trial Comparing Bariatric Surgery Vs. Intensive Medical Weight Management on Diabetes Remission In Patients With Type 2 Diabetes And Bmi 30-35; The Role of Srage Diabetes Biomarker As Predictor of Success

A125 - Long-Term Follow-Up of Pilot Randomized Trial Comparing Bariatric Surgery Vs. Intensive Medical Weight Management on Diabetes Remission In Patients With Type 2 Diabetes And Bmi 30-35; The Role of Srage Diabetes Biomarker As Predictor of Success

Metabolic Surgery: Roux-en-Y Gastric Bypass and Variables Associated with Diabetes Remission in Patients with BMI &lt;35

Metabolic results of bariatric surgery have determined an expansion of its traditional indications, being increasingly performed in non-severely obese patients, especially in type 2 diabetes mellitus (T2DM). Our aim is to determine the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in T2DM remission in patients with body mass index (BMI) below 35kg/m(2) and the variables associated with T2DM remission after surgery. Retrospective analysis of diabetic patients with BMI <35kg/m(2) who underwent LRYGB in our center between 2002 and 2010 was done. We analyzed patient's demographics, comorbidities, BMI, excess weight loss percentage (EWLp), complications, and metabolic results at 3years. Univariate and multivariate analyses were performed to determine variables associated with T2DM remission. One hundred patients were included. Sixty patients (60%) were women; median age was 48years old (interquartile range (IQR) 42-54), and median preoperative BMI was 32.7kg/m(2) (IQR 31.6-34.1). Median preoperative duration of T2DM was 4years (IQR 2-7), with 49, 30, 2, and 18% on treatment with one, two, and three hypoglycemic agents and insulin, respectively. Ninety-four percent achieved 36-month follow-up, and at this time, median EWLp was 93% (IQR 67-121). A total of 53.2, 9.6, 25.5, and 11.7% achieved a T2DM complete remission, partial remission, improvement, and no improvement, respectively. T2DM remission only was associated with non-insulin use in multivariate analysis, with an OR = 15.1 (2.8-81.2) and p = 0.002. LRYGB is a reliable and effective treatment in diabetic patients with a BMI <35kg/m(2) at 3years. T2DM remission's best results are observed in non-insulin diabetic patients.

Metabolic Surgery Is No Longer Just Bariatric Surgery

Metabolic Surgery Is No Longer Just Bariatric Surgery

Remission of diabetes in patients with long‐standing type 2 diabetes following placement of adjustable gastric band: a retrospective case control study

Rates of remission in obese patients with long-standing type 2 diabetes (>2 years), following an adjustable gastric band are unclear. We conducted a retrospective case-control study of patients (n = 89) matched for age and body mass index with non-surgical controls. Cases had a longer duration of diabetes (99 ± 53 and 80 ± 59 months, p < 0.05) and a lower HbA1c than controls (7.9 ± 1.6 vs. 8.5 ± 1.9%, p < 0.05). At follow-up (median 105 weeks) cases had lost 16.8 ± 13.5 kg and controls 1.7 ± 8.9 kg (p < 0.001) and HbA1c decreased by 0.6-0.8% (p < 0.001 for time) with no difference between cases and controls. Diabetes resolution, defined by HbA1c less than 6.5% and taking no medications, occurred in 14 (16%) cases and 2 controls. This is in contrast to published outcomes of resolution of type 2 diabetes after bariatric surgery. We conclude that there is a clear need for randomized studies of the effect of gastric banding in patients with long-standing type 2 diabetes.

Hypoglycaemia following diabetes remission in patients with 6q24 methylation defects: expanding the clinical phenotype

Hypoglycaemia following diabetes remission in patients with 6q24 methylation defects: expanding the clinical phenotype

Bariatric surgery to treat type 2 diabetes

To critically discuss the strengths and shortcomings of recent progress achieved with bariatric surgery in patients with type 2 diabetes mellitus (T2DM), focussing on efficacy aspects (remission of diabetes and cardiovascular comorbidities). Despite an increasing armamentarium of pharmacotherapeutics to overcome several challenges, only 10% of T2DM patients achieve a composite goal of HbA1c, blood pressure and lipids. Bariatric surgery has emerged as a solution to these challenges in morbid obesity. Whether the same advantages can be translated into T2DM remains a matter of debate, certainly regarding safety, durability of diabetes recovery and long-term outcome. Bariatric surgery in T2DM patients with a BMI of at least 35 kg/m(2) has been shown to result in a 56% excess body weight loss, resolution of hypertension in 62%, amelioration of dyslipidaemia in greater than 70% and diabetes remission in 57-95%, depending on the type of surgery and the definition of diabetes resolution. These impressive results, and the fact that diabetes recovery often occurs before prominent weight loss is evident, have urged bariatric surgeons to consider surgical procedures as a valuable approach for diabetes control and diabetes remission in patients with a BMI ranging between 30 and 35 kg/m(2). Bariatric surgery is emerging as a valid option to treat T2DM, improving glycaemia and cardiovascular risk factors. However, there needs to be an agreed definition of resolution of diabetes in future studies and long-term efficacy is to be proven. For now, the challenge is to determine how to offer bariatric surgery in a responsible fashion.