Which patients with diabetes achieve total remission after bariatric surgery?

The study showed that patients with shorter diabetes duration, younger age, higher BMI, lower preoperative fasting blood sugar and HbA1c, not on insulin, and not having a family obesity history achieved prolonged diabetes remission.

Obesity is a global public health concern, with more than 650 million adults being affected by it. The prevalence of type 2 diabetes mellitus (T2DM) almost tripled between 1975 and 2016. Also, it increased with obesity, with more than 422 million people affected by T2DM and 1.5 million deaths directly to diabetes each year. This has been referred to commonly as 'diabesity'. Hence, diabesity prevention and treatment is a significant public health priority. Bariatric surgery is a surgical procedure for the remission of type 2 diabetes.

Previous studies on various bariatric surgeries comprising T2DM patients showed an overall remission rate of hyperglycemia. However, not much is known about predictive factors on remission following different surgery types. Therefore, Ali Kabir and colleagues from Iran aimed to identify the remission rate of type 2 diabetes and assess the effects of preoperative factors characteristics of type 2 diabetes remission in Iran.

For this purpose, the researchers conducted a retrospective analysis of 1351 T2DM patients by operated by three different surgeries (One Anastomosis Gastric Bypass (OAGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB)). The remission of diabetes was defined per the criteria of the American Diabetes Association (ADA).

The study led to the following findings:

• Of a total of 1351 patients, 475 (35.2%) were undergoing RYGB, 675 patients (50.0%) OAGB, and 201 (14.9%) sleeve gastrectomy.
• 81.7%, 82.6% of RYGB, 77.1%, 81.5% of SG, and 80.6%, 84.2% of OAGB participants were in type 2 diabetes remission after 1 and 3 years, respectively.
• 1- and 3-year remission was linked with preoperative age, duration of T2DM, BMI, FBS and HbA1c, insulin therapy, and a family obesity history.

"The findings showed weight loss and improvement in blood sugar control and diabetes remission after the three types of bariatric surgery as described in the study," the researchers wrote. "The higher diabetes remission rates are seen in younger patients with lower fasting blood sugar and HbA1c, higher preoperative BMI, with shorter diabetes duration who were not on insulin and not having a family history of obesity at one year and three years following the bariatric surgery.

Interestingly, the study also showed that a family history of obesity could play a critical role in predicting T2DM remission. According to the authors, no study has attributed to the family history of obesity.

Reference:

Moradi, M., Kabir, A., Khalili, D. et al. Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB): results of the longitudinal assessment of bariatric surgery study. BMC Endocr Disord 22, 260 (2022). https://doi.org/10.1186/s12902-022-01171-8