Article

Ten-year duration of type 2 diabetes as prognostic factor for remission after sleeve gastrectomy.

Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, Sapienza University of Rome, Italy.
Surgery for Obesity and Related Diseases (impact factor: 3.93). 7(6):697-702. DOI:10.1016/j.soard.2011.08.014 pp.697-702
Source: PubMed

ABSTRACT Several studies have demonstrated a high rate of type 2 diabetes mellitus (T2DM) resolution after sleeve gastrectomy. Different prognostic factors have been hypothesized for T2DM remission after bariatric surgery. Our objectives were to analyze the role of T2DM duration as an independent prognostic factor for remission.
From January 2008 to September 2010, 56 obese patients with T2DM underwent sleeve gastrectomy. Group A consisted of 16 patients who had lived with T2DM for >10 years (12 women and 4 men, mean body mass index 42.7 kg/m2). Group B included 40 obese patients who had lived with T2DM for <10 years (29 women and 11 men, mean body mass index 44.9 kg/m2).
In group A, 43.7% were treated with oral hypoglycemics, 6.3% with insulin, and 50% with oral hypoglycemics and insulin. In group B, 87.5% were treated with oral hypoglycemics, 5% with dietary therapy, and 7.5% with insulin. The preoperative average glycemia, glycosylated hemoglobin, and C-peptide value was 206.2 mg/dL, 9.5%, and 2.8 μg/L in group A and 134 mg/dL, 7.1%, and 4.5 μg/L in group B, respectively (P < .05 for all). The T2DM remission rate in all 56 patients was 80.3%. However, in group B, the resolution rate was 100%, but in group A, the resolution rate was 31%. Patients without complete remission were more sensitive to lower doses of antidiabetic drugs.
Sleeve gastrectomy is effective in the treatment of obese patients with T2DM. The duration of T2DM seems to be of paramount importance as a prognostic factor, with 10 years representing a cutoff between a 100% rate of remission and significantly lower rates of remission.

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    Article: Predictors for Remission of Major Components of the Metabolic Syndrome After Biliopancreatic Diversion with Duodenal Switch (BPDDS).
    Villy Våge, Roy M Nilsen, Arnold Berstad, Jan Behme, Nils Sletteskog, Ronny Gåsdal, Camilla Laukeland, Gunnar Mellgren
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    ABSTRACT: BACKGROUND: Metabolic surgery causes the remission of type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia to varying degrees, depending on the patient characteristics and the surgical procedure. The aim of this study was to find predictors for the remission of T2DM and hypertension after biliopancreatic diversion with duodenal switch (BPDDS). METHODS: Eighty patients with T2DM were followed up for 2 years or more after BPDDS, and changes in body weight and metabolic status were noted. Remission was defined as fasting glucose <7 mmol/l with HbA1C <6.5 %, blood pressure <140/90 mmHg, and low-density lipoprotein (LDL) <2.6 mmol without the use of medication. RESULTS: Preoperatively, the mean age was 44 years, body mass index (BMI) was 48 kg/m(2), and duration of diabetes was 5 years. Of the 80 patients, 38 patients were using insulin, 48 patients were using antihypertensives, and 38 patients were using a lipid-lowering drug. Five percent of the patients had recommended levels for HbA1C, blood pressure, and LDL prior to the operation. The remission rate at 2 years was 94 % for T2DM, 54 % for hypertension, and 86 % for LDL hyperlipidemia. Preoperative predictors for nonremission of T2DM were a higher BMI, insulin usage, and low insulin C-peptide, and for hypertension, older age and more severe hypertension. Postoperative weight loss was important for both. CONCLUSIONS: Surgical intervention with BPDDS is an effective treatment of T2DM, hypertension, and hyperlipidemia. The duration of T2DM and age of the patient are the most important preoperative predictors for the remission of T2DM and hypertension, respectively.
    Obesity Surgery 09/2012; · 3.29 Impact Factor
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Keywords

16 patients
 
40 obese patients
 
56 obese patients
 
56 patients
 
antidiabetic drugs
 
C-peptide value
 
complete remission
 
Different prognostic factors
 
glycosylated hemoglobin
 
group B
 
independent prognostic factor
 
lower doses
 
lower rates
 
obese patients
 
oral hypoglycemics
 
Sleeve gastrectomy
 
T2DM duration
 
T2DM remission
 
T2DM remission rate
 
type 2 diabetes mellitus
 

Giovanni Casella