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The impact of bariatric surgery on insulin-treated type 2 diabetes patients

Abstract

Introduction

Bariatric surgery has been shown to lead to significant improvement in glucose homeostasis, resulting in greater rates of type 2 diabetes mellitus (T2DM) remission. While there is substantial evidence of the benefits of bariatric/metabolic surgery in obese diabetic patients on oral therapy (O-T2D), more evidence is necessary in the case of insulin-treated type 2 diabetes (I-T2D) patients and the selection of surgical procedure.

Methods

Analysis of the Ontario Bariatric Registry data was performed, comparing outcomes of Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on insulin-treated versus non-insulin-treated T2DM patients. We compared weight loss, medication use and remission rates during a 3-year follow up.

Results

A total of 3668 diabetic Bariatric Registry patients underwent surgery from Jan 2010 to Feb 2017, across 7 Bariatric Centers of Excellence in Ontario. Of these 2872 were O-T2D and 1187 were I-T2D. Weight loss was similar between the two groups at 3 years; with mean %WL of 30.1% for the insulin group vs. 28.3% non-insulin (p = 0.0673). At 3 years, 11.3% of the non-insulin and 59.6% of the insulin-dependent group were using anti-diabetic medication (p < 0.0001). Among insulin-dependent patients, RYGB showed greater reduction in insulin use with 26.5 and 40% compared to SG at 3 years. O-T2D patients experienced more complete diabetes remission, with 66.5 vs. 18.5% (p < 0.0001) at 3 years. Complete remission for I-T2D patients was higher in the RYGB group than SG (p < 0.0001) at years 1 and 2 (8.5 vs. 5.4% and 24.4 vs. 21.1%). The same trend was found regardless of insulin use; complete remission higher for RYGB at 1 and 2 years [50.7 vs. 39.8% (p < 0.0001), and 54.6 vs. 49.1% (p < 0.0001)].

Conclusion

While both RYGB and SG procedures provide effective treatment for I-T2D patients in terms of weight loss and diabetes, incidence of complete remission for insulin-dependent patients is higher with RYGB in earlier years.

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Abbreviations

AGB:

Adjustable gastric banding

BMI:

Body mass index

BPD:

Biliopancreatic diversion

HbA1c:

Glycated hemoglobin (A1C)

I-T2D:

Insulin-treated type 2 diabetes

O-T2D:

Oral-treated type 2 diabetes

%WL:

Percent weight loss

%EWL:

Percent excess weight loss

SG:

Sleeve gastrectomy

RCT:

Randomized control trial

RYGB:

Roux-en-Y gastric bypass

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

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Acknowledgments

The authors would like to acknowledge the data management team at the Population Health Research Institute (PHRI) who provide statistical analysis of the Bariatric Registry, and who assisted in the analysis for this study.

Funding

The Ontario Ministry of Health and Long-Term Care (MOHLTC) support the Ontario Bariatric Registry.

Author information

Correspondence to Mehran Anvari.

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Conflict of interest

Drs. Lemus, Karni, Hong, Gmora, Anvari and Ms. Breau have no conflict of interest or financial ties to disclose.

Additional information

Presented at the SAGES 2017 Annual Meeting, March 22–25, 2017, Houston, Texas.

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Lemus, R., Karni, D., Hong, D. et al. The impact of bariatric surgery on insulin-treated type 2 diabetes patients. Surg Endosc 32, 990–1001 (2018). https://doi.org/10.1007/s00464-017-5777-5

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Keywords

  • Diabetes mellitus
  • Sleeve gastrectomy
  • Gastric bypass
  • Insulin dependence
  • Remission