Do T2DM super-super obese patients benefit from bariatric surgery?

Raquel Gonzalez-Heredia MD. PhD, Valeria Valbuena, BS, Mario Masrur, MD, Kristin Patton, MD, Crystal Hernandez, BS, Melissa Murphey, DNP, NP-C, Lisa Sanchez-Johnsen PhD, Enrique F Elli, MD, FACS. UCI

Introduction: Among the population of obese adults (BMI >30 kg/m2), the super-super obese (BMI >60 kg/m2) present particular challenges for the bariatric surgeon. Surgical management of these patients has been associated with higher morbidity and mortality. A major morbidity in relation to super super-obesity, type 2 diabetes mellitus (T2DM), increases the probability of unsustainable weight loss goals and surgical risk. The aim for this study is to evaluate the effects of bariatric surgery on the major morbidity rate of T2DM in super-super obese patients and not super-super obese patients.

Materials and Methods: This study is a nonrandomized, controlled, retrospective review of 750 patients who underwent bariatric surgery at the University of Illinois Health and Science System from January 2008 to June 2014. Patients were divided in two groups regarding BMI. Super-super obese patients (BMI>60 kg/m²) in Group 1 and not-super-super obese patients (BMI<60 kg/m²) in Group 2.Patient demographics, comorbidities, postoperative morbidity and mortality, operating time, length of stay, and % excess weight loss (%EWL) were reviewed. The association with T2DM was uniquely studied in both groups prior to and after surgery.The improvement in T2DM was noted if the patient had a decrease in daily medications at 24 months after surgery. Statistical analysis was performed comparing aforementioned data related to T2DM and %EWL at 24 months follow up between the two groups using T-test student and Chi-square test as needed.

Results: The super-super obese group comprised a total of 89 patients (%12) with a mean age, at the time of surgery, of 38.9 years (standard deviation [SD] ± 10.2).The not super-super obese group included 661 patients (88%) with a mean age of 42.3 years (SD±10.3) and statistical differences between the two groups (p=0.003). The prevalence of T2DM in the super-super obese group was 33.7 % (SD ± 0.5) prior to surgery with no statistical differences comparing to the not super-super obese group with a prevalence of 64.7% (p=0.478). There were no statistical differences in postoperative complications or length of stay between the groups. At 24 months follow up, the decrease in T2DM medications was compared between the super-super obese patients and the not-super-super obese patients. The mean decrease in T2DM medications for the super-super obese patients was 17.9% and that was statistically different (p=0.018) from the mean decrease in T2DM medications for the not-super-super obese patients (7.7%).The mean excess weight loss values (%EWL) at 24 months was 51.8% (SD ± 19.9 kg/m2) in the super-super obese patients with no statistical differences (p=0.123) comparing with the not-super-super obese patients (EWL=60% SD ± 26.9 kg/m2).

Conclusions: Overall bariatric surgery is a safe and effective procedure for the management of super-super obese patients. Results showed a better improvement of T2DM in the super-super obese patients in comparison to the not super-super patients.

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