Diabetics who never used insulin may have sustained remission after bariatric surgery

In a recent study, Type 2 diabetes patients who had never used insulin showed sustained remission 10 years after bariatric surgery in a prospective study of 85 patients.

Having diabetes for less than 5 years was also predictive of achieving long-term diabetes remission, Diego Moriconi, MD, of the University of Pisa (Italy) and presenting study investigator, reported at the virtual annual meeting of the European Association for the Study of Diabetes.

"Weight loss was associated with type 2 diabetes remission 1 year after surgery, but it had no impact on the long-term relapse of diabetes," Dr. Moriconi said.

If patients were taking insulin, for instance, the take-home would seem to be not to expect too much in terms of remission of their diabetes, Dr. Vilsbøll said. She added: "Usually I am not a big fan of [relying on] diabetes duration because often we know that patients with type 2 diabetes have had diabetes for a long time before they're diagnosed." However, "it seems to be very important here."

The research team reported the findings of an observational study that had started in 2006 and recruited individuals about to undergo bariatric surgery for type 2 diabetes. Participants were evaluated before a surgery and every 6-12 months after, undergoing various clinical and laboratory investigations, for 10 years.

The majority of the recruited patients (76%) were women. Most (also 76%) had undergone gastric bypass (Roux-en-Y) surgery, and the remainder had undergone sleeve gastrectomy. Both types of surgery were equally as good at getting people into remission, as defined by the American Diabetes Association Standards of Medical Care in Diabetes, Dr. Moriconi said. As such, remission was achieved if the fasting blood glucose fell below 100 mg/dL and the hemoglobin A1c below 5.7%.

On analysis, the following results emerged.

· In the first year following surgery, 75% of patients had met diabetes remission criteria. This fell to 61% of patients after 5 years, and to 55% at 10 years.

· At each of these time points, 25% of patients had type 2 diabetes, with 14% relapsing back at 5 years and 20% at 10 years.

· Different characteristics were noted in 47 patients who had achieved diabetes remission at 10 years, compared with the 17 who had "relapsed" back to having type 2 diabetes and the 21 who had remained with type 2 diabetes.

· The decrease in body mass index achieved at 10 years was no difference between the three groups. However, 1 year after surgery, there had been a significantly greater drop in the body in those who achieved remission, compared with those who did not (P = .04).

· Patients who achieved remission at 1, 5, and 10 years were more likely to have had diabetes for less than 5 years than those who remained with type 2 diabetes. The average duration of diabetes was 2 years in those achieving remission versus 8 years in those who had relapsed and 13 years in those who had remained diabetic (P < .0001).

"Glycemic control improved with time in all the three groups after bariatric surgery, although more markedly so in the remission group," Dr. Moriconi said. He highlighted how none of the patients who had achieved remission had used insulin, whereas 12% of those who had relapsed and a half (52%) of those who remained with type 2 diabetes had used insulin (P < .0001).

The findings are important, commented Tina Vilsbøll, MD, DMSc, chief consultant at the Steno Diabetes Centre Copenhagen, who chaired the session. They're important because they would help "to set the expectations for patients before they have surgery, what to expect in respect to resolution or remission of diabetes.

"SOURCE: Moriconi D. EASD 2020, Oral presentation 120.