Diabetes Mellitus Remission Research Articles

Alternative ways to correct poor glucose metabolism in patient with diabetes mellitus

There is an annual increase in the incidence of diabetes recorded worldwide. The existing measures of prevention and multimodal treatment of the disease have not yet brought the desired results. A promising field is bariatric (metabolic) operations used in obese patients, which also improve glucose metabolism in the case of concomitant diabetes mellitus of both types 1 and 2. At the same time, there is a certain contradiction and understatement regarding the mechanisms that lead to remission of diabetes mellitus, regardless of weight loss. One of the anatomical effects of bariatric procedures is the accelerated release of nutrients into the distal segment of the small intestine, which leads to stimulation of enteroendocrine cells and increased secretion of incretins (GLP-1, PYY, etc.). The experiment investigates these mechanisms by the operation of ileal transposition. Further study of the ileal transposition effects using different models of type 1 and type 2 diabetes, accompanied both with and without obesity, may contribute to a more detailed understanding of the triggering and supporting mechanisms of increasing glucose tolerance in the struggle against this disease.

Adequate magnesium level as an associated factor of pre-diabetes and diabetes mellitus remission in patients with obesity submitted to bariatric surgery

Bariatric surgery (BS) can lead to remission of type 2 diabetes mellitus (T2DM), however, the evidence on the influence of preoperative serum magnesium levels on this reversal is scarce. To study the influence of preoperative serum magnesium levels on the pre-T2DM and T2DM remission one year after BS. Retrospective study carried out among 1656 patients with obesity who underwent BS in the Centro Hospitalar Universitário São João. T2DM and pre-T2DM remission were defined as being normal glycaemic measures of at least one year’s after BS and without pharmacological therapy. To assess the association between preoperative serum magnesium levels and pre- and T2DM remission, logistic regression models, crude and adjusted for sex, age and body mass index were computed. Patients with normoglycaemia presented hypomagnesaemia less often than those patients with pre-T2DM and T2DM (17.0% vs. 21.3% vs. 39.9%) (p < 0.001). One year after BS, 62.9% of patients with pre-T2DM or T2DM before BS showed remission. Adequate magnesium levels were positively associated with T2DM and pre-T2DM remission, one year after BS (OR 1.79; 95% CI 1.34–2.38), independently of sex, age, and body mass index. Adequate preoperative serum magnesium levels showed to be an important clinical parameter for pre-T2DM and T2DM remission.

EP.TH.239Outcomes and Complications After Sleeve Gastrectomy

Abstract Aim The sleeve gastrectomy (SG) is a popular bariatric procedure that has beneficial effects that go beyond that of simply reducing obesity. It also has positive effects on diabetes, dyslipidaemia, and hypertension. Method The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including “bariatric surgery”, “sleeve gastrectomy”, “complications”, “hypertension”, “diabetes”, “dyslipidaemia”, “cardiovascular” and “obesity”. Result SG leads to improvement in hypertension, type 2 diabetes, increased HDL levels, and reduction in uraemia levels that were present even after 10 years. Approximately 56-59% of patients experience type 2 diabetes mellitus remission after a year following a SG operation, and the beneficial effects of the operation on diabetes continue long after a year, with 84-86% of patients noting remission after a 5-year period. Approximately 78.5% who undergo SG will see improvements in hypertension, whilst 67.1% will report resolution. On the other hand, complications include formation of strictures (0.7-4% in patients), haemorrhage (1.5% of patients), and leakage (1.5-2.4%). Additional complications include alteration to bile flow, disruption to microbiota, and disruption to vagus nerve activity. Conclusion Complications from SG are uncommon but can be severe, and the involved mechanisms are only partially revealed. However, optimisation of risk factors in the months leading up to the operation can significantly improve outcomes in patients. This involves an early implementation of a healthy lifestyle including advising patients to exercise more regularly and adopt a low fat, low salt diet, limiting alcohol, and cessation of smoking.

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery.

Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

Changes in the Proteome Profile of People Achieving Remission of Type 2 Diabetes after Bariatric Surgery.

Bariatric surgery (BS) results in metabolic pathway recalibration. We have identified potential biomarkers in plasma of people achieving type 2 diabetes mellitus (T2DM) remission after BS. Longitudinal analysis was performed on plasma from 10 individuals following Roux-en-Y gastric bypass (n = 7) or sleeve gastrectomy (n = 3). Sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) was done on samples taken at 4 months before (baseline) and 6 and 12 months after BS. Four hundred sixty-seven proteins were quantified by SWATH-MS. Principal component analysis resolved samples from distinct time points after selection of key discriminatory proteins: 25 proteins were differentially expressed between baseline and 6 months post-surgery; 39 proteins between baseline and 12 months. Eight proteins (SHBG, TF, PRG4, APOA4, LRG1, HSPA4, EPHX2 and PGLYRP) were significantly different to baseline at both 6 and 12 months post-surgery. The panel of proteins identified as consistently different included peptides related to insulin sensitivity (SHBG increase), systemic inflammation (TF and HSPA4—both decreased) and lipid metabolism (APOA4 decreased). We found significant changes in the proteome for eight proteins at 6- and 12-months post-BS, and several of these are key components in metabolic and inflammatory pathways. These may represent potential biomarkers of remission of T2DM.

Effect of low carbohydrate diets on insulin resistance and the metabolic syndrome.

Purpose of reviewThis review outlines recent research in the application of low carbohydrate diets (LCD) for insulin resistance (IR) and metabolic syndrome (MetS).Recent findingsStudies included in this review explore how a LCD can be used in the management of patients with IR and MetS. LCDs have been shown to result in Type 2 Diabetes Mellitus (T2DM) remission, improve lipid profiles and dramatically reduce intrahepatic fat.SummaryThe field of nutritional science is notoriously complex. The LCD has a simple narrative, which can easily and safely be applied in clinical practice. Current guidelines recognise and encourage the use of LCD as a valid option for patients with T2DM and obesity. Structured, evidence-based education should be available for all clinicians to increase confidence and ensure consistency and quality control. Further real-world evidence into the application and scalability of a LCD are required. The use of digital health solutions and improved health technology should see significant advances in this field, with dietary habit being driven by patient-derived health data in response to food, and not population-based food guidelines. The narrative around MetS and IR needs to change from progression to remission, with a LCD being a valid option for this.

Improvement of Diabetes Mellitus After Colorectal Cancer Surgery: A Retrospective Study of Predictive Factors For Type 2 Diabetes Mellitus Remission and Overall Survival.

PurposeThe purpose of the current study was to evaluate the impact of colorectal cancer (CRC) surgery on type 2 diabetes mellitus (T2DM) and to analyze the change in T2DM on overall survival after CRC surgery.MethodsPatients who underwent CRC surgery were retrospectively enrolled from January 2013 to December 2019. The status of T2DM pre- and 1-year after CRC surgery was recorded, and predictive factors for T2DM remission and overall survival were analyzed.ResultsA total of 296 patients were included in this study. Thirty-eight patients experienced remission of T2DM 1 year after CRC surgery, and the remission rate was 12.8%. Weight loss was significantly higher in the T2DM remission group (p = 0.038), and the T2DM duration was significantly shorter in the T2DM remission group (p = 0.015). In the multivariate logistic regression analysis, higher weight loss (p = 0.046, odds ratio = 1.060, 95% CI = 1.001–1.122) and shorter T2DM duration (p = 0.019, odds ratio = 1007, 95% CI = 1.001–1.014) were predictive factors for remission of T2DM. Furthermore, in multivariate Cox regression analysis, lower TNM stage (p = 0.000, odds ratio = 2.147, 95% CI = 1.474–3.128) and T2DM remission (p = 0.033, odds ratio = 2.999, 95% CI = 1.091–8.243) were the predictive factors for better overall survival.ConclusionPatients with concurrent CRC and T2DM had a 12.8% remission 1 year after CRC surgery. Higher weight loss and shorter T2DM duration contributed to T2DM remission, and patients with T2DM remission could improve in terms of their overall survival.

Sex disparity in laparoscopic bariatric surgery outcomes: a matched-pair cohort analysis

Men have been historically considered to be higher-risk patients for bariatric surgery compared to women, the perception of which is suggested to be a barrier to bariatric surgery in men. The purpose of this study is to conduct a matched-pair analysis to evaluate sex disparities in laparoscopic bariatric surgery outcomes. Data on patients who underwent laparoscopic bariatric surgery from March 2013 to 2017 was collected prospectively. Then, 707 men and 707 women pair-matched for age, preoperative body mass index (BMI) and the procedure type (i.e., sleeve gastrectomy, Roux-en-Y, or one-anastomosis gastric bypass) were compared in terms of weight loss, remission of obesity-related comorbidities, and postoperative complications classified according to the Clavien–Dindo classification. There was no difference between the two sexes regarding the operation time, bleeding during surgery and length of postoperative hospital stay. We observed similar total weight loss, BMI loss, and percentage of excess BMI loss at 12, 24, and 36 months postoperatively between men and women, with no difference in remission of diabetes mellitus, hypertension and dyslipidemia at 12 months. The rate of in-hospital, 30-day and late complications according to Clavien–Dindo classification grades was similar between men and women. Our matched-pair cohort analysis demonstrated that bariatric surgery results in comparable short- and mid-term efficacy in men and women, and is associated with similar rate and severity of postoperative complications between sexes. These findings suggest bariatric surgeons not to consider sex for patient selection in bariatric surgery.

Effects of Roux-en-Y Gastric Bypass on Type 2 Diabetes Mellitus

Abstract Abstract: Bariatric surgery is the most effective treatment for classes II and III obesity patients. This surgically induced weight loss is associated with better glycemic control and higher type 2 diabetes mellitus (T2DM) remission rate compared to conventional medical therapy. Roux-en-Y gastric bypass (RYGB) is the most commonly technique performed, and its risks and benefits are well known. We sought to assess the effects of one-year post-RYGB on glycemic control and T2DM remission in a tertiary care teaching public hospital in Porto Alegre, Southern Brazil. This retrospective cohort study included all patients submitted to RYGB between 2010 and 2019 at Hospital de Clínicas de Porto Alegre. Type 2 diabetes mellitus remission was defined as the absence of oral antidiabetic medication and insulin use in association with a glycosylated hemoglobin (HbA1c) &amp;lt;6.5% one-year post-RYGB. This study was approved by the local Ethics Committee (2018-0088). A total of 549 RYGB procedures were performed from 2010 to 2019 among patients aged 42.2 ± 10.7 years, mostly women (84.7%), white (88%), and with a body mass index (BMI) of 49.4 ± 8.5 kg/m². The preoperative prevalence of T2DM was 31.2% (n=171), of which 93.6% used oral antidiabetic medication and 15.6% used insulin. Among T2DM patients, 39% used at least two oral antidiabetic drugs in association, most of them being metformin (91%) and sulfonylureas (19.3%). Preoperative fasting plasma glucose and HbA1c were 143 ± 48.1 mg/dL and 7.3 ± 1.6%, respectively, reducing to 93.6 ± 21.3 mg/dL (p&amp;lt;0.001) and 5.4 ± 0.7% (p=0.002), respectively, one year after RYGB. Excess weight loss one-year post-RYGB was 68.7 ± 17.1%, similar between patients with and without T2DM (p=0.48). At 12 months, 77.4% of T2DM patients discontinued their oral antidiabetic drugs or insulin, and the disease remission rate was 71.3%. Bariatric surgery was effective for T2DM remission among classes II and III obesity patients, which is in accordance with the current literature. Support: CNPq, FIPE (HCPA)

Type 2 Diabetes Mellitus Remission in Obese Patients Under Bariatric Surgery: The Role of Preoperative Triglycerides Levels

Background: There is abundant evidence reporting the relationship between triglycerides levels and type 2 diabetes mellitus, however few studies confirmed the influence of triglycerides levels on the incidence of diabetes. Bariatric surgery may lead to the remission of type 2 diabetes mellitus, but the effect of basal serum triglycerides levels on this reversal is unknown. This study aimed to assess the association between preoperative triglycerides levels and pre- and type 2 diabetes mellitus remission in obese patients one year after bariatric surgery. Methods: A retrospective study was conducted among 1959 obese patients who underwent bariatric surgery in our entre. Data on socio-demographic and clinical characteristics were used. Pre-diabetes and type 2 diabetes mellitus remission was defined as normal glycaemic measures at least one year’s duration without pharmacological therapy. Logistic regression models, crude and adjusted for sex, age, preoperative serum triglycerides levels and type of bariatric surgery, were used. Results: The median of preoperative serum triglycerides level was 121.00 (SD=75.00) mg/dL, and 34.7% and 30.0% of patients presented pre- and type 2 diabetes mellitus, respectively, at baseline. Preoperative serum triglycerides levels were higher in type 2 diabetes mellitus patients (139.00 vs. 106.00 mg/dL, in normal glycaemic patients; p<0.001) and showed to be significantly correlated with fasting glycaemia, glycatedhaemoglobin, homeostasis model assessment of insulin resistance and homeostasis model assessment of β-cell function. One year after bariatric surgery, 62.5% of patients with pre- or type 2 diabetes at baseline showed remission. Preoperative serum triglycerides levels were negatively associated with this remission (OR: 0.997; 95%CI=0.995–0.998), independently of, sex, age and type of bariatric surgery. Conclusions: One year after bariatric surgery, 62.5% of patients showed pre- or type 2 diabetes mellitus remission, being the preoperative serum triglycerides levels an important clinical parameter for remission. Keywords: triglycerides, diabetes, remission, obesity, bariatric surgery

Incidence and disease course of new-onset diabetes mellitus in breast and colorectal cancer patients undergoing chemotherapy: A prospective multicenter cohort study

AimsTo investigate the incidence of and risk factors for new-onset type 2 diabetes mellitus (DM) developed during chemotherapy that included steroids in cancer patients without DM. MethodsThis multicenter, prospective, and observational cohort study enrolled 299 cancer patients without DM (aged > 18 years), planning 4–8 cycles of adjuvant chemotherapy. The endpoints were the incidence, remission rate, and independent determinants of new-onset DM during chemotherapy. ResultsBetween April 2015 and March 2018, 270 subjects with colorectal cancer or breast cancer (mean age, 51.0 years) completed the follow up (mean 39 months). Of whom, 17 subjects (6.3%) developed DM within a median time of 90 days (range, 17–359 days). Male sex (hazard ratio [HR], 15.839; 95% confidence interval [CI], 2.004–125.20) and impaired fasting glucose (IFG) at baseline (HR, 8.307; CI, 1.826–37.786) were independent risk factors. Six months after chemotherapy completion, 11/17 subjects (64.7%) experienced DM remission, associated with a significantly higher C-peptide level at baseline (C-peptide levels, 1.3 ng/mL in subjects with remission and 0.9 ng/mL in subjects without remission, age- and sex-adjusted P = 0.007). ConclusionsDM incidence was 6.3% in patients who received chemotherapy with dexamethasone. Close monitoring for hyperglycemia is recommended, especially for men with IFG.Trial registration: ClinicalTrials.gov (NCT03062072).

Laparoscopic Roux-en-Y Gastric Bypass After Failed Vertical Banded Gastroplasty: 2-Year Follow-up of 102 Patients

Vertical banded gastroplasty (VBG) is now discarded from being a restrictive procedure for morbid obesity due to its many drawbacks, doubtful efficacy, and lots of post-operative complications. Roux-en-Y gastric bypass (RYGB) is the most commonly performed procedure for VBG revision. So we aimed at reporting our experience in conversional RYGB for a failed VBG. Analyzing follow-up records of 102 patients who underwent revisional RYGB after failed VBG in the period from April 2014 to January 2018. A total of 102 laparoscopic revisions of failed VBGs to RYGB were performed. The mean operating time was 161.9 min ±29.2 and the mean length of the hospital stay was 1.5 days ±1.2. Fourteen patients (13%) developed early post-operative complications (gastrojejunostomy leak 5; bleeding 9). Four patients (4.7%) developed late complications (Port site hernia 2; internal hernia 1; Stomal ulcer 1). The mean BMI pre-RYGB was 46.6 ± 5.9 kg/m2, and the mean %EBWL (percent excess body weight lost) of the patients at 12 and 24 months post-revision were 56.2% and 64.3%, respectively. Our patients had immediate post-revision resolution of VBG-related complications like dysphagia and vomiting. We also report improvement in all obesity-related health problems with (75.7%) complete remission rate and (24.3%) partial remission or improvement rate of diabetes mellitus. Conversion of VBG to RYGB is a feasible procedure and is associated with acceptable early morbidity rates and reduced lengths of hospitalization also it provides acceptable weight loss and improvement in obesity-related health problems. Graphical Abstract.

Efficacy of Different Procedures of Metabolic Surgery for Type 2 Diabetes in Asia: a Multinational and Multicenter Exploratory Study.

Asian patients with diabetes exhibit different characteristics from Western patients. However, limited large-scale data are available on metabolic surgery procedures in Asia. We compared the short-term efficacies of metabolic surgery procedures for the management of Asian patients with different severities of diabetes. We included patients undergoing metabolic surgery in five Asian institutions from January 2008 to December 2015 with at least 1-year postoperative follow-up. Outcomes of weight loss and diabetes control were determined. Diabetes remission rates in different ABCD scores and factors affecting diabetes remission were analyzed. A total of 1016 patients (mean BMI, 39.0 ± 7.2kg/m2; HbA1c, 8.3% ± 1.7%) underwent metabolic surgery (197, Roux-en-Y gastric bypass [RYGB]; 171, one anastomosis gastric bypass [OAGB]; 437, sleeve gastrectomy [SG]; 130, SG with duodenal-jejunal bypass [SG-DJB]; and 81, single anastomosis duodenal-jejunal bypass with SG [SA-DJBSG]). The OAGB group exhibited significantly higher 1-year total weight loss (30.5%) and type 2 diabetes mellitus (T2DM) remission (78.4%) rates than did the other groups (p < .001). The patients with higher preoperative ABCD scores exhibited higher T2DM remission rates (81.8-100% and 9.5-46.2% in ABCD score subgroups of 9-10 and 1-2, respectively). In multivariate analysis, bypass was found to be an independent predictor of T2DM remission compared with SG (odds ratio of OAGB vs SG, 3.72; RYGB vs SG, 1.96; SG-DJB vs SG, 2.73; SA-DJBSG vs SG, 2.12). The metabolic surgeries are highly effective in T2DM treatment. However, SG may not be as effective as gastric bypass and duodenal-jejunum bypass.

Remission of Diabetes Mellitus in Two Patients with Maturity-Onset Diabetes of the Young After Bariatric Surgery

Remission of Diabetes Mellitus in Two Patients with Maturity-Onset Diabetes of the Young After Bariatric Surgery

C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass

OBJECTIVES:Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission.METHODS:We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770®) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM.RESULTS:The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass.CONCLUSION:Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.

Short-term results of single-anastomosis gastric bypass after failed sleeve gastrectomy

Background It is recognized that sleeve gastrectomy (SG) is one of the most common bariatric procedures worldwide. It is considered a relatively safe and effective option in the treatment of morbid obesity. However, SG operations may fail in the treatment of obesity. In cases of unsuccessful SG surgery, revisional bariatric surgery may be used. One anastomosis gastric bypass (OAGB) was considered as an outstanding choice for revision surgery. Objective To assess the efficacy and safety of OAGB as a redo surgery after the failure of previous sleeve gastrectomy operation. Patients and methods This study is a retrospective cohort study, conducted in Bariatric Surgery Unit, Ain Shams University Hospital, Cairo, Egypt, from February 2018 to July 2019, with 6 months of postoperative follow-up till January 2020. We included 50 patients who underwent OAGB who were adults fit for surgery, aged between 18 and 60 years, with a history of failed SG. Results A total of 50 patients with history of failed SG underwent OAGB surgery with excess body weight loss of 14.10% at 1 month, 28.85% at 3 months, and 45.43% at 6 months. Weight loss was 7.14–32.43 kg (SD 6.14). The type 2 diabetes mellitus remission rate was 100% by 6 months, with glycated hemoglobin level of 5.88±0.77 (range, 5.4–7.2). Hypertension resolution was 40%. Overall, 100% of patients with sleep apnea improved symptomatically. No morbidity or mortality cases were reported. Conclusion OAGB operation is considered to be an effective and safe revisional surgical procedure after a failed primary SG operation.

Morbid obesity in clinical practice: current treatment concepts

The article discusses modern methods of treatment of morbid obesity and associated diseases. It is known that obesity leads to disability in people, including young people, due to the frequent development of severe comorbid diseases. According to current clinical guidelines, the main goals of treating obese patients are: weight loss, achieving good metabolic control, and improving the course of diseases associated with obesity. A small selection of drugs for the treatment of obesity, the need for strict adherence to indications and contraindications to their appointment, significantly limits the possibilities of drug therapy for morbid obesity. With morbid obesity, the effectiveness of conservative treatment is only 510%. Up to 60% of patients cannot maintain the result of weight loss within 5 years of observation. Long-term use of bariatric surgeries, the purpose of which was initially to reduce body weight in patients with morbid obesity, showed certain possibilities of surgery in compensating for a number of diseases associated with obesity. Therefore, at present, the concept of bariatric surgery is not only to reduce the patients weight, but also to achieve beneficial metabolic effects (normalization of glycemia, lipid metabolism). In this regard, modern bariatric interventions are united by the term metabolic surgery. It has been proven that compensation of non-insulin-dependent diabetes mellitus after bariatric interventions is observed in 4295% of patients, depending on the type of surgery, duration of non-insulin-dependent diabetes mellitus and basal C-peptide level. As a result of many years of research, bariatric surgery has allowed for the first time to formulate the term remission of non-insulin dependent diabetes mellitus.

Role of DiaRem Score in Preoperative Prediction of Type 2 Diabetes Mellitus Remission After Laparoscopic Roux-en-Y Gastric Bypass: Indian Perspective.

Roux-en-Y gastric bypass (RYGB) has emerged as the most effective treatment in reversing insulin resistance in patients with type 2 diabetes mellitus (T2DM). A number of models and statistical tools have been proposed to predict patients likely to experience diabetes remission post-RYGB. The purpose of our study was to evaluate the preoperative accuracy of DiaRem score in predicting T2DM remission at 1year of follow-up in a retrospective analysis of diabetic morbidly obese patients who underwent RYGB. One hundred and forty-three patients underwent RYGB between January 2018 and December 2018. We conducted a retrospective analysis in 55 patients (38.46%) with T2DM with 1year of follow-up. DiaRem score was calculated, and patients were stratified in five groups. At a 1-year follow-up, we found a higher proportion of patients with T2DM remission in the lower score group compared to a lower proportion of patients with remission in the higher score group. We derived a DiaRem cut-off score of 6.5 that had high sensitivity and specificity to predict T2DM remission preoperatively. We found a significant decrease in BMI and HbA1C values post-operatively at 1year following RYGB. DiaRem score is an easy to determine score based on basic clinical parameters that could identify patients with T2DM who would achieve maximal benefit in terms of remission after bariatric surgery. The development of a suitable scoring tool would be clinically useful as it would enable clinicians to better triage patients for RYGB.

Does Roux-en-Y Construction Really Bring Benefit of Type2 Diabetes Mellitus Remission After Gastrectomy in Patients with Gastric Cancer? A Systematic Review and Meta-Analysis.

IntroductionTo evaluate whether the extent of gastrectomy or the reconstruction method brings benefit of type 2 diabetes mellitus (T2DM) remission after gastrectomy in patients with gastric cancer.MethodsPUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched to find eligible studies published from inception to July 31, 2020.ResultsA total of nine studies (1424 patients) were included. At the first year and the end of follow-up time after gastrectomy, the total gastrectomy group had better T2DM remission than the subtotal gastrectomy group, and the Roux-en-Y reconstruction (R-Y) group had better T2DM remission compared with the non-R-Y group. There was no difference between R-Y and non-R-Y in terms of subtotal gastrectomy (OR 1.08, 95% CI 0.63–1.84, P = 0.78). However, total gastrectomy with R-Y had better T2DM remission than subtotal gastrectomy with R-Y (OR 2.75, 95% CI 1.19–6.35, P = 0.02).ConclusionTotal gastrectomy with R-Y had better T2DM remission. The extent of gastrectomy rather than the reconstruction method might play an important role in T2DM remission after gastrectomy in patients with gastric cancer.

Role of Laparoscopic Ileal Interposition Associated with Sleeve Gastrectomy in Management of Type 2 Diabetes Mellitus

Abstract Background: Type 2 diabetes mellitus has reached pan-demic levels with associated many co-morbidities and decrease in life expectancy. Bariatric surgery presented its value as a definitive solution for type 2 diabetes mellitus management especially with the laparoscopic surgery evolution which occurred since the 1990s. Bariatric surgery has a significant role in remission or alleviation of type 2 diabetes mellitus, weight loss, remission of comorbidities, and the improvement in the quality of life. Aim of Study: We attempt to illustrate, through the available researches, the role of laparoscopic ileal interposition associ-ated with sleeve gastrectomy in management of type 2 diabetes mellitus and the feasibility and efficacy of this procedure as an option in management of type 2 diabetes mellitus and assess the risk to benefit profiles. Material and Methods: The search is carried out using the electronic national library of medicine's PubMed database plus manual reference checks of articles published on lapar-oscopic ileal interposition associated with sleeve gastrectomy in management of type 2 diabetes mellitus in the period between February 2019 to February 2020. The jejuno-ileal interposition associated with sleeve gastrectomy can be an effective method used for management of type 2 diabetes mellitus in patients with BMI less than 35 kg/m2. Results: The results of this procedure are promising regarding its outcome in remission of T2DM and remission of its co-morbidity diseases. The operative time of the proce-dure along with its reasonable post-operative hospital stay and its results in type 2 diabetes mellitus remission may present the procedure as an alternative for other more complex bariatric procedures in management of type 2 diabetes mellitus. Conclusion: The duration time of T2DM, the drug used, the dose of the drug and the BMI of the patient affect the rate of complete remission of T2DM. The procedure can produce adequate control of hyperglycemic state in T2DM patients and satisfactory weight loss without signs of nutritional deficiencies. The procedure seems to be safe and an effective option in the management of type 2 diabetes patients with affordable risk comparing to its long term benefits.