Should remission of type 2 diabetes mellitus be the foremost goal after bariatric surgery?

Ana Ramos-Levi; Pilar Matia; Lucio Cabrerizo; Ana Barabash; Andres Sanchez-Pernaute; Carmen Hernandez; Alfonso Calle-Pascual; Antonio Torres; Miguel Rubio

doi:10.1530/endoabs.32.P775

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Endocrine Abstracts (2013) 32 P775 | DOI: 10.1530/endoabs.32.P775

ECE2013 Poster Presentations Obesity (65 abstracts)

Should remission of type 2 diabetes mellitus be the foremost goal after bariatric surgery?

Ana Ramos-Levi ¹ , Pilar Matia ¹ , Lucio Cabrerizo ¹ , Ana Barabash ¹ , Andres Sanchez-Pernaute ² , Carmen Hernandez ² , Alfonso Calle-Pascual ¹ , Antonio Torres ² & Miguel Rubio ¹

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¹Department of Endocrinology and Nutrition, IdISSC, Hospital Clinico San Carlos, Madrid, Spain; ²Department of Surgery, IdISSC, Hospital Clinico San Carlos, Madrid, Spain.

Introduction: Remission of type 2 diabetes (T2D) is a yearned outcome after bariatric surgery (BS). Attention to individuals who do not strictly fulfil remission criteria has been frequently left behind. The aim of this study was to evaluate metabolic control status in patients considered as diabetes ‘non-remitters’.

Materials and methods: Retrospective study of 125 patients (59.2% women) with preoperative diagnosis of T2D who underwent BS in a single centre (2006–2011). Anthropometric and metabolic parameters, before surgery and at one-year follow-up. Definition of T2D remission according to Buse et al.: HbA1c <6%, fasting glucose (FG) <100 mg/dl, absence of pharmacologic treatment. Analysis of non-remitters and their metabolic status according to ADA’s target recommendations of glucose and lipid control: HbA1c <7%, c-LDL <100 mg/dl, triglycerides <150 mg/d, cHDL >40 (male) or >50 mg/dl (female). Statistics: ANOVA.

Results: Preoperatively (mean±S.D.): age 53.5±9.7 years, BMI 43.5±5.6 kg/m², duration of T2D 7.7±7.9 years, FG 162.0±56.3 mg/dl, HbA1c 7.7±1.6%. At baseline, ADA’s target recommendations were present in 12 (9.6%) and at one year follow-up in 45 (36%) individuals (P=0.000). 62 (49.6%) patients did not achieve diabetes remission; 26 (41.9%) had now diet treatment only, 30 (48.4%) oral medications and 6 (9.7%) required insulin. Of the non-remitters, 57 (91.9%) had HbA1c <7 and 18 (40.0%) achieved ADA’s target recommendations. There were no differences between remitters and non-remitters in the number of individuals reaching ADA’s target glucose and lipid levels.

Conclusions: Although almost 50% of patients may not be classified as diabetes remitters, they achieve a significant improvement in glucose and lipid control, which should be considered a success according to most scientific societies’ target recommendations.