Remission of type 2 diabetes mellitus after bariatric surgery — comparison between procedures
Abstract
Introduction: We aimed to assess the mid-term type 2 diabetes mellitus recovery patterns in morbidly obese patients by comparing some relevant physiological parameters of patients of bariatric surgery between two types of surgical procedures: mixed (roux-en-Y gastric bypass and biliopancreatic diversion) and restrictive (sleeve gastrectomy).
Material and methods: This is a prospective and observational study of co-morbid, type 2 diabetes mellitus evolution in 49 morbidly obese patients: 37 underwent mixed surgery procedures and 12 a restrictive surgery procedure. We recorded weight, height, body mass index, and glycaemic, lipid, and nutritional blood parameters, prior to procedure, as well as six and twelve months post-operatively. In addition, we tested for differences in patient recovery and investigated predictive factors in diabetes remission.
Results: Both glycaemic and lipid profiles diminished significantly to healthy levels by 6 and 12 months post intervention. Type 2 diabetes mellitus showed remission in more than 80% of patients of both types of surgical procedures, with no difference between them. Baseline body mass index, glycated haemoglobin, and insulin intake, among others, were shown to be valuable predictors of diabetes remission one year after the intervention.
Conclusions: The choice of the type of surgical procedure did not significantly affect the remission rate of type 2 diabetes mellitus in morbidly obese patients. (Endokrynol Pol 2017; 68 (1): 18–25)
Keywords: type 2 diabetes mellitusbariatric surgerygastric bypassbiliopancreatic diversionsleeve gastrectomy
References
- International Diabetes Federation (IDF). International Year Book and Statesmen's Who's Who. .
- Holman RR, Paul SK, Bethel MA, et al. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131): 837–853.
- Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009; 122(3): 248–256.e5.
- Arterburn DE, Campos GM, Haneuse S, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013; 23(1): 93–102.
- Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007; 357(8): 753–761.
- Cremieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008; 14(9): 589–596.
- Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012; 366(17): 1577–1585.
- Zimmet P, Alberti KG, Rubino F, et al. IDF's view of bariatric surgery in type 2 diabetes. Lancet. 2011; 378(9786): 108–110.
- Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab. 2009; 35(6 Pt 2): 518–523.
- Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery. Obes Surg. 2004; 14(6): 840–848.
- Robert M, Ferrand-Gaillard C, Disse E, et al. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques. Obes Surg. 2013; 23(6): 770–775.
- Moya MP, Charneco MQ, Soto MLF. Trastornos nutricionales tras cirugía bariátrica y su tratamiento. Endocrinología y Nutrición. 2007; 54: 42–47.
- Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998; 22(9): 936–946.
- Larrad Á, Sánchez-Cabezudo C. Indicadores de calidad en cirugía bariátrica y criterios de éxito a largo plazo. Cirugía Española. 2004; 75(5): 301–304.
- Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009; 32(11): 2133–2135.
- Quinn G, Keough M. Experimental Design and Data Analysis for Biologists. 2009.
- Wolfe BM, Purnell JQ, Belle SH. Treating diabetes with surgery. JAMA. 2013; 309(21): 2274–2275.
- Lips MA, de Groot GH, van Klinken JB, et al. Calorie restriction is a major determinant of the short-term metabolic effects of gastric bypass surgery in obese type 2 diabetic patients. Clin Endocrinol (Oxf). 2014; 80(6): 834–842.
- Benetti A, Del Puppo M, Crosignani A, et al. Cholesterol metabolism after bariatric surgery in grade 3 obesity: differences between malabsorptive and restrictive procedures. Diabetes Care. 2013; 36(6): 1443–1447.
- Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007; 132(6): 2253–2271.
- Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013; 309(21): 2240–2249.
- Rawlins L, Rawlins MP, Brown CC, et al. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis. 2013; 9(1): 21–25.
- Heneghan HM, Cetin D, Navaneethan SD, et al. Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis. 2013; 9(1): 7–14.
- Kumar AA, Palamaner Subash Shantha G, Kahan S, et al. Intentional weight loss and dose reductions of anti-diabetic medications--a retrospective cohort study. PLoS One. 2012; 7(2): e32395.
- Franco JV, Ruiz PA, Palermo M, et al. A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding. Obes Surg. 2011; 21(9): 1458–1468.
- Kashyap SR, Gatmaitan P, Brethauer S, et al. Bariatric surgery for type 2 diabetes: weighing the impact for obese patients. Cleve Clin J Med. 2010; 77(7): 468–476.
- Lakdawala MA, Bhasker A, Mulchandani D, et al. Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg. 2010; 20(1): 1–6.
- Jiménez A, Casamitjana R, Flores L, et al. Long-term effects of sleeve gastrectomy and Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012; 256(6): 1023–1029.
- Peterli R, Wölnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009; 250(2): 234–241.
- Lee WJ, Chen CY, Chong K, et al. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2011; 7(6): 683–690.
- Ting CH, Syu YF, Chen LY, et al. Perspectives on interventional diabetology: Duodenal exclusion is promising for human type 2 diabetes mellitus remission. Nutrition. 2016; 32(1): 141–145.
- Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012; 22(5): 740–748.
- Saeidi N, Meoli L, Nestoridi E, et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science. 2013; 341(6144): 406–410.
- Laferrère B, Reilly D, Arias S, et al. Differential metabolic impact of gastric bypass surgery versus dietary intervention in obese diabetic subjects despite identical weight loss. Sci Transl Med. 2011; 3(80): 80re2.
- Kohli R, Setchell KDr, Kirby M, et al. A surgical model in male obese rats uncovers protective effects of bile acids post-bariatric surgery. Endocrinology. 2013; 154(7): 2341–2351.
- van Rutte PWJ, Smulders JF, de Zoete JP, et al. Sleeve gastrectomy in older obese patients. Surg Endosc. 2013; 27(6): 2014–2019.
- Taylor R. Type 2 diabetes: etiology and reversibility. Diabetes Care. 2013; 36(4): 1047–1055.
![](https://journals.viamedica.pl/plugins/generic/popups/images/icons/close.png)