Shohan Shetty, MD, Jaime P Almandoz, MD, Ibrahim I Jabbour, MD, MPH, Nancy Puzziferri, MD. UT Southwestern Medical Center (Dallas, TX)
Obese patients in the Veterans Affairs (VA) Health Care System who undergo bariatric surgery differ from their civilian counterparts, as they are predominantly men, older aged, carry greater obesity related comorbidity burden and are of lower socioeconomic status. While studies have shown bariatric surgery significantly improves glycemic control and cardiometabolic risk factors, there is limited longitudinal data from the Veteran population. This study evaluated the long-term outcomes of VA patients following Roux-en-Y Gastric Bypass (RYGB) in regards to weight loss, type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia.
A retrospective review was conducted on consecutive patients diagnosed with T2DM who underwent RYGB at the VA North Texas Health Care System between 2003 and 2011. Data collection included demographics, absolute weight, body mass index (BMI), associated diagnoses, medications, and remission rates. Remission was defined as: hemoglobin A1c (HgbA1c) <6.5%, without medications for T2DM; blood pressure <140/90 mmHg without medications for hypertension; and cholesterol <200 mg/dl, high density lipoprotein (HDL) >40 mg/dl, low density lipoprotein (LDL) <160 mg/dl, and triglycerides <200 mg/dl, without medications for hyperlipidemia. Outcome means for absolute weight and BMI were compared by t test. Reported p values are 2-sided and considered significant at <0.05.
Eighty-five T2DM patients (73% males; mean age 54 years) underwent RYGB. Mean pre-operative weight and BMI were 151 kg (range 103–229 kg) and 49 kg/m2 (range 35–81 kg/m2), respectively. Ninety-two percent of patients also had hypertension and 84% had hyperlipidemia. All diagnoses were made by referral physicians, documented on the medical record, and treated with medication. At 4 years post-operation, with 80% follow-up, the mean weight was 107 kg (±57 SD; p <0.001) and mean BMI 46.2 kg/m2 (±7.2 SD; p <0.05). Preoperative mean HbA1c of 6.9 %(±1.2 SD) decreased to 6.3 %(±1.4 SD; p<0.01) postoperatively. Twenty-seven patients (31%) had remission of T2DM. Mean blood pressures did not meaningfully differ after RYGB (133/73 pre- versus 129/75 mmHg post-operation). Twelve patients (15%) had remission of hypertension. Cholesterol and LDL levels did not decrease significantly post-operation (172 to 159 mg/dl; p=0.06 and 92 to 82 mg/dl; p=0.11, respectively). HDL and triglycerides changed significantly after RYGB (42 to 54 mg/dl; p<0.001, and 198 to 124 mg/dl; p<0.001 respectively). The remission rate for hyperlipidemia was 15%.
Long-term follow-up of VA patients with obesity and T2DM who underwent RYGB demonstrated significant and durable weight loss with marked improvement in obesity-related comorbidities including glycemic control, hypertension, and hyperlipidemia.