Suriya Punchai, MD1, Zubaidah NorHanipah, MD1, Katherine Meister, MD1, Tracy Hull, MD2, Luca Stocchi, MD2, Philip Schauer, MD1, Stacy Brethauer, MD1, Ali Aminian, MD1. 1Bariatric and Metabolic Institute, Cleveland Clinic, 2Colorectal Surgery, Cleveland Clinic Foundation
Introduction: Gastrectomy and diversionary gastroduodenal procedures can improve type 2 diabetes (T2D). Colorectal resection alters intestinal microbiome and might be associated with favorable hormonal changes. The aim of the study was to study the possible evolution of T2D in patients who underwent colectomy.
Methods: All patients with T2D who underwent colectomy for benign diseases from 2004 to 2015 at a single academic center who had at least 1-year postsurgical follow up were identified. We excluded patients with colorectal malignancies, inflammatory bowel diseases, and patients on immunosuppressive medications. Baseline characteristics, pre-operative and post-operative BMI, glycated hemoglobin (HbA1c), and diabetes medications were collected. Data was summarized as the median and interquartile range (IQR) for continuous variables and as counts and percentages for categorical variables. A paired t test and Wilcoxon signed-rank test were used to calculate the difference between the last follow up point and baseline at the time of surgery. Two dependent proportions were compared with Z-test.
Results: A total of 171 T2D patients who underwent colorectal resection for benign diseases were identified with a median postsurgical follow up of 3 years (IQR 1-5). Ninety nine (58%) patients were female and median age was 67 years (IQR 56-75). The median duration of diabetes to colectomy was 3 years (IQR 1-7). Underlying colorectal diseases included diverticulitis (n=112, 65%), adenomatous polyps (n=37, 22%), ischemic colitis (n=10, 6%), volvulus (n=6, 3.5%), colonic inertia (n=3, 2%), severe C. difficile colitis (n=2, 1%) and Ogilvie syndrome (n=1, 0.5%). Colectomy procedures include sigmoid colectomy (n=91, 53%), right hemi-colectomy (n=45, 27%), left hemi-colectomy (n=12, 7%), total colectomy (n=12, 7%), anterior resection (n=7, 4%) and transverse colectomy (n=4, 2%). The median BMI at baseline and post-colectomy were 30.3 kg/m2 (IQR 26.6-34.6) and 30.4 kg/m2 (IQR 26.2-35), respectively (p=0.1). The median HbA1c at baseline and post-colectomy were 6.7% (IQR 6.2-7.5) and 6.5% (IQR 6.5-7.1), respectively (p=0.5). The proportion of patients taking diabetes medications at baseline versus post-colectomy was 75% versus 71% (p=0.3) and the proportion of patients on insulin was 32% versus 40% (p=0.1). Furthermore, the postsurgical weight and glycemic outcomes were not associated with the type of colorectal resections.
Conclusion: Data of this exploratory analysis indicate that colectomy is not associated with significant improvement of T2D.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79631
Program Number: P564
Presentation Session: Poster (Non CME)
Presentation Type: Poster
