Metabolic response 4 years after gastric bypass in a complete cohort with type 2 diabetes mellitus. (March 2018)

• Record Type: Journal Article
• Authors: Carranza-Leon, B. Gisella; Puzziferri, Nancy; Adams-Huet, Beverley; Jabbour, Ibrahim; Lingvay, Ildiko
• Is Part Of: Diabetes research and clinical practice. Volume 137(2018)
• Page Start: 224
• Page End: 230
• Publication Date: 2018-03
• Subjects: Type 2 diabetes mellitus -- Gastric bypass -- Weight loss -- Hypertension -- Hyperlipidemia -- Complications; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.11.022
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Long-term diabetes outcomes after surgery are rarely reported in complete cohorts. The type 2 diabetes remission rate was 49% at 4 years after gastric bypass. Remission rates for other metabolic comorbidities were lower than for diabetes. Long-term surgical or nutritional complications occurred in up to 44% patients. Abstract: Aims: To evaluate the long-term remission rates of type 2 diabetes mellitus and associated comorbidities after gastric bypass surgery in a complete cohort, in a real-life clinic setting. Methods: A retrospective study of all consecutive patients with type 2 diabetes mellitus who underwent gastric bypass at a Veterans Affairs Medical Center from 2003 to 2010. The main outcome was remission of type 2 diabetes mellitus defined as HbA1c <6.5% (49 mmol/mol) without diabetic medication usage. Secondary outcomes were remission of hypertension and hyperlipidemia, weight loss, and long-term complications four years post-gastric bypass. Results: Eighty-four patients with type 2 diabetes mellitus underwent gastric bypass. Four-year follow-up data were available for 92% (77/84) of patients. The patients (73% male; mean age 54 years) had a mean body mass index of 49 kg/m 2 ± 8.3. Hypertension and hyperlipidemia prevalence were 92% and 85%, respectively. The mean total body weight decrease over four years was 35 kg ± 21. Remission of type 2 diabetes mellitus occurred in 15% at 6 months and 49% four years after surgery. Diabetes remission was more likely (OR 3.2; 95% confidence interval 1.2–9.7) in patients not using insulin at baseline. Remission rates were 12% (9/74) for hypertension and 16% (11/68) for hyperlipidemia. Long-term surgical complications included reoperation (11%), incisional hernia (10%) and anastomotic ulcer (10%). Forty-four percent of patients had one or more nutritional complications. Conclusions: The metabolic effects of gastric bypass are significant and durable for at least four years, even in a predominantly male cohort and real-life clinical setting.