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Weight Loss Directly Influences Intermediate-Term Remission of Diabetes Mellitus After Bariatric Surgery: A Retrospective Case-Control Study

  • R. de La HarpeEmail author
  • S. Rüeger
  • Z. Kutalik
  • P. Ballabeni
  • M. Suter
  • N. Vionnet
  • B. Laferrère
  • F. Pralong
Original Contributions
  • 55 Downloads

Abstract

Purpose

Roux en Y gastric bypass surgery (RYGB) is an effective therapy for patients with severe obesity. It induces both significant weight loss and rapid improvements of metabolic complications. This study was undertaken to better define the direct role of weight loss in the metabolic improvements.

Methods

A retrospective, case-control study of a cohort of 649 patients with obesity who underwent RYGB, comparing higher and lower responders at 2 years after surgery (n = 100 pairs). Pairs of patients were matched for age, gender, and initial BMI. The rates of remission of diabetes, hypertension, dyslipidemia, and hyperuricemia were compared using a mixed effects logistic regression analysis.

Results

Diabetes before surgery was present in 12/100 lower responders and 17/100 higher responders. Remission at 2 years was observed in 4/12 (33%) of lower responders, compared to 15/17 (88%) of higher responders. Thus, the odds of diabetes remission was significantly smaller in lower responders (OR = 0.067, 95% CI 0.01–0.447). A mixed model regression analysis of all the parameters for each patient showed that the odds of achieving remission of any comorbidity was significantly lower in lower responders (OR = 0.62, 95% CI = 0.39–0.97).

Conclusion

We could demonstrate that weight loss is a significant determinant of the remission of diabetes 2 years after RYGB. These data underline the importance of weight loss in the benefits of this procedure.

Keywords

Obesity Roux-en-y gastric bypass surgery Metabolic comorbidities Weight loss Remission of diabetes mellitus 

Notes

Acknowledgments

R.L. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with ethical standard of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local institutional review board.

References

  1. 1.
    WHO | Obesity and overweight [Internet]. WHO. [cité 5 oct 2016]. Disponible sur: http://www.who.int/mediacentre/factsheets/fs311/en/
  2. 2.
    Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA. 282(16):1523–9.CrossRefGoogle Scholar
  3. 3.
    Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55.CrossRefGoogle Scholar
  4. 4.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.CrossRefGoogle Scholar
  5. 5.
    Duvoisin C, Favre L, Allemann P, et al. Roux-en-Y Gastric bypass: Ten-year results in a cohort of 658 patients. Ann Surg. 2018;268(6):1019–25.CrossRefGoogle Scholar
  6. 6.
    Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. In: The Cochrane Collaboration, éditeur. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2014 [cité 13 avr 2016]. Disponible sur:  https://doi.org/10.1002/14651858.CD003641.pub4
  7. 7.
    Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6. discussion 757-758PubMedPubMedCentralGoogle Scholar
  8. 8.
    Courcoulas AP, Yanovski SZ, Bonds D, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;149(12):1323–9.CrossRefGoogle Scholar
  9. 9.
    Mehaffey JH, LaPar DJ, Clement KC, et al. 10-Year outcomes after Roux-en-Y gastric bypass. Ann Surg. 2016;264(1):121–6.CrossRefGoogle Scholar
  10. 10.
    Ahmed B, King WC, Gourash W, et al. Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the longitudinal assessment of bariatric surgery (LABS) study. Surgery. 2018;164(4):774–83.CrossRefGoogle Scholar
  11. 11.
    Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(3):489–506.CrossRefGoogle Scholar
  12. 12.
    Patti M-E, Houten SM, Bianco AC, et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism. Obes Silver Spring Md. 2009;17(9):1671–7.CrossRefGoogle Scholar
  13. 13.
    Thaler JP, Cummings DE. Minireview: Hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.CrossRefGoogle Scholar
  14. 14.
    Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30(7):1709–16.CrossRefGoogle Scholar
  15. 15.
    Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741–9.CrossRefGoogle Scholar
  16. 16.
    Moo T-A, Rubino F. Gastrointestinal surgery as treatment for type 2 diabetes. Curr Opin Endocrinol Diabetes Obes. 2008;15(2):153–8.CrossRefGoogle Scholar
  17. 17.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet Lond Engl. 2015;386(9997):964–73.CrossRefGoogle Scholar
  18. 18.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med. 376(7):641–51.CrossRefGoogle Scholar
  19. 19.
    Campos GM, Rabl C, Peeva S, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg. 2010;14(1):15–23.CrossRefGoogle Scholar
  20. 20.
    Bradley D, Conte C, Mittendorfer B, et al. Gastric bypass and banding equally improve insulin sensitivity and β cell function. J Clin Invest. 2012;122(12):4667–74.CrossRefGoogle Scholar
  21. 21.
    Sjöholm K, Sjöström E, Carlsson LMS, et al. Weight change–adjusted effects of gastric bypass surgery on glucose metabolism: 2- and 10-year results from the Swedish Obese Subjects (SOS) study. Diabetes Care. 2016;39(4):625–31.CrossRefGoogle Scholar
  22. 22.
    Pucci A, Tymoszuk U, Cheung WH, et al. Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores. Diabet Med J Br Diabet Assoc. 2018;35(3):360–7.CrossRefGoogle Scholar
  23. 23.
    Favre L, Marino L, Roth A, et al. The reduction of visceral adipose tissue after Roux-en-Y gastric bypass is more pronounced in patients with impaired glucose metabolism. Obes Surg. 2018;28(12):4006–13.CrossRefGoogle Scholar
  24. 24.
    Taylor R, Al-Mrabeh A, Zhyzhneuskaya S, et al. Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery. Cell Metab. 2018;28(4):547–556.e3.CrossRefGoogle Scholar
  25. 25.
    Steven S, Carey PE, Small PK, et al. Reversal of Type 2 diabetes after bariatric surgery is determined by the degree of achieved weight loss in both short- and long-duration diabetes. Diabet Med J Br Diabet Assoc. 2015;32(1):47–53.CrossRefGoogle Scholar
  26. 26.
    Blanchard C, Moreau F, Ayer A, Toque L, Garçon D, Arnaud L, et al. Roux-en-Y gastric bypass reduces plasma cholesterol in diet-induced obese mice by affecting trans-intestinal cholesterol excretion and intestinal cholesterol absorption. Int J Obes 2005. 2018;42(3):552-60.CrossRefGoogle Scholar
  27. 27.
    Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.CrossRefGoogle Scholar
  28. 28.
    Association AD. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S13-27.Google Scholar
  29. 29.
    Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Service of Internal MedicineMorgesSwitzerland
  2. 2.Faculty of Biology and MedicineUniversity of Lausanne (UNIL)LausanneSwitzerland
  3. 3.School of Life Sciences, EPFLLausanneSwitzerland
  4. 4.Swiss Institute of BioinformaticsLausanneSwitzerland
  5. 5.Center for Primary Care and Public Health (Unisanté)University of Lausanne (UNIL)LausanneSwitzerland
  6. 6.Clinical Research Center (CRC)Lausanne University Hospital (CHUV)LausanneSwitzerland
  7. 7.Department of Visceral SurgeryLausanne University Hospital (CHUV)LausanneSwitzerland
  8. 8.Department of SurgeryRiviera-Chablais HospitalAigle-MontheySwitzerland
  9. 9.Service of Endocrinology, Diabetes and MetabolismLausanne University Hospital (CHUV)LausanneSwitzerland
  10. 10.New York Obesity Nutrition Research Center, Divison of Endocrinology, Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUnited States
  11. 11.Center for Endocrinology, Diabetology and ObesityLa Tour Private HospitalMeyrinSwitzerland

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