bariatric surgery

Preoperative Insulin Use Determines Diabetes Remission After Bariatric Surgery

Patients with diabetes who have lower preoperative glycosylated hemoglobin (A1c) levels and do not use insulin have better remission rates 6 months and 1 year after bariatric surgery, according to results of a new analysis.

To conduct their analysis, the researchers reviewed data on 186 obese patients with diabetes who had undergone a sleeve gastrectomy or a Roux-en-Y gastric bypass surgery at a US academic hospital. They also assessed preoperative A1c and pharmacologic therapy to determine diabetes remission rates at 6 months and 1 year after surgery.

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Patients were also categorized as insulin-dependent diabetics (IDDs) or noninsulin-dependent diabetics (NIDDs).

At 6 months post-surgery, patients who were categorized as having a preoperative A1c of:

  • Less than 6.5% had a remission rate of 70.5%;
  • 6.5% to less than 8% had a remission rate of 51.7%; and
  • 8% or more had a remission rate of 30.0%.

At 6 months, preoperative pharmacologic therapy analysis showed that patients with an A1c of 6.5% to less than 8% had remission rates of 23.5% for IDDs and 64.1% for NIDDs. For patients with an A1c of 8% or more, the remission rates were 24.0% for IDDs and 37.5% for NIDDs.

At 1 year post-surgery, patients who were categorized as having a preoperative A1c of:

  • Less than 6.5% had a remission rate of 72.0%;
  • 6.5% to 8% had a remission rate of 54.0%; and
  • 8.1% or more had a remission rate of 42.8%.

At 1 year, preoperative pharmacologic therapy analysis showed that patients with an A1c of 6.5% to less than 8% had remission rates of 30.0% for IDDs and 62.9% for NIDDs. For patients with an A1c of 8% or more, the remission rates were 31.4% for IDDs and 61.9% for NIDDs.

“While a difference was observed between overall A1c levels—the lower the A1c level, the higher the remission rate—IDD patients had lower remission rates than NIDD patients irrespective of A1c levels,” the researchers concluded. “Further, IDD patients performed similarly across A1c levels.”

—Amanda Balbi

Reference:

Hariri K, Guevara D, Jayaram A, Kini SU, Herron DM, Fernandez-Ranvier G. Preoperative insulin therapy as a marker for type 2 diabetes remission in obese patients after bariatric surgery. 2018;14(3):332-337. https://doi.org/10.1016/j.soard.2017.11.016.