William Neal, BS, Raquel Gonzalez-Heredia, MD, PhD, Omar Jamil, BS, Lisa Sanchez-Johnsen, PhD, Enrique Elli, MD, FACS. UIC
Introduction: For many obese individuals with type II diabetes, pharmaceutical and lifestyle intervention alone or in combination are insufficient methods for glycemic control. The purpose of this study was to determine the percent and number of patients who partially or completely resolved their diabetes post-RYGB as measured by HbA1c, fasting plasma glucose (FPG), and pharmaceutical usage.
Material and Methods: This is a retrospective cohort study where 135 patients with type II diabetes were identified from 324 patients who underwent roux-en-y gastric bypass surgery at the University of Illinois Hospital & Health Sciences System (Chicago, IL) between June 2008 and June 2015. Partial and complete remissions were based upon American Diabetes Association criteria: Partial remission was defined as HbA1c < 6.5% or FPG 100-125 mg/dL; Complete remission was defined as HbA1c < 5.7% or FPG < 100mg/dL. Glucose levels were classified as follows: Normal glucose (< 100mg/dL), pre-diabetes (100-125 mg/dL) and diabetes (> 125mg/dL). This study also included decreased or discontinued medications as partial and complete remission, respectively. Data was analyzed using SPSS statistical software and p values < 0.05 were considered statistically significant.
Results: In regards to HbA1c, 29% of the diabetic patients achieved partial remission by 3-months. The pre-operative mean HbA1c was 7.8%, recorded by 71% (n=96) of patients. By three-months, 21% (n= 28) achieved partial remission (<6.5%) with a mean HbA1c of 6.2% and at 12-months the mean HbA1c was 5.9%. Eighty-six patients (64%) were lost to follow-up over the 12-month span. As expected, pre-operative mean FPG for non-diabetics was normal (96.9 mg/dL), while the diabetic mean FPG was 147 mg/dL. Three months post-RYGB, diabetics (n=39) reported a 21% decrease mean FPG to 116.6 mg/dL into the pre-diabetic range. Additional data was gathered for decreases or discontinuations in medications past three months. In diabetic patients, 83.7% (n=113) followed up to record pharmaceutical changes during post-operative visits starting at three months. Results revealed that at any follow-up beyond three months post-surgery, 35.4% (n=40) achieved partial remission by decreasing at least one medication while 42% (n=47) achieved complete resolution by discontinuing at least one medication.
Conclusions: Previous research has demonstrated that partial resolution of type II diabetes and decreases in HbA1c, glucose and medications are reasonable outcomes to expect post-surgery. Additional studies with larger sample sizes and longer follow-up are needed to further examine partial and complete remission of diabetes post RYGB surgery.