Original articleType 2 diabetes after gastric bypass: remission in five models using HbA1c, fasting blood glucose, and medication status
Section snippets
Study design
We performed a retrospective analysis of data prospectively collected from a cohort of 2275 patients who qualified for bariatric surgery under the standards defined by the 1991 National Institutes of Health Consensus Conference [26] and underwent RYGB in a community hospital from 2001 to 2008. For patients diagnosed preoperatively with T2DM, remission was defined using a composite of FG and HbA1c values combined with diabetes medication status by 14 months after surgery. The institutional
Preoperative demographics
The characteristics of the total population are listed in Table 1. Of the 2275 patients (79.8% women, 86.7% white) who underwent RYGB, 1312 (57.7%) had normoglycemia, 296 (13%) had impaired fasting glucose (at risk of T2DM), and 667 (29.3%) had T2DM before surgery. The patients who were at risk of T2DM and those who had T2DM weighed more (P = .008), were older, and had a greater number of co-morbidities (P < .001) than the patients with normoglycemia. The patients with T2DM had greater FG and
Discussion
Using the current criteria (a composite of FG <100 mg/dL, HbA1c <5.7%, and no diabetes medication), our data revealed T2DM remission to normoglycemia by 14 months after RYGB in 218 (43.2%) of the 505 patients or 200 (53.8%) of 372 noninsulin-requiring patients and 18 (13.5%) of 133 insulin-requiring patients. Both the preoperative absence of insulin therapy and a shorter duration with a known diagnosis of T2DM independently predicted remission by 14 months. Even among those patients not
Conclusion
We propose defining T2DM remission after bariatric surgery as a return to normoglycemia and the discontinuation of diabetes medications using current ADA criteria for both FG and HbA1c. Even with these more stringent criteria, a number of patients achieved remission and discontinued all diabetes medications within 14 months. Also, the estimates of preoperative disease severity (shorter known T2DM duration and not requiring insulin therapy) were robust and independent predictors for the
Acknowledgment
We acknowledge the nursing and clinical staff at Scottsdale Bariatric Center and Scottsdale Healthcare for their kind and compassionate care of patients.
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Cited by (0)
Supported in part (contribution of J.C.B.) by the Intramural Research Program of the National Institutes of Health and National Institute of Diabetes and Digestive and Kidney Diseases.
Disclosures The authors have no commercial associations that might be a conflict of interest in relation to this article.