Mehran Anvari, MB, BS, PhD, FRCSC, FACS1, Ruth Breau, BA2, Dennis Hong, MD, MSc, FRCSC, FACS1, Scott Gmora, MD, FRCSC, FACS1. 1McMaster University, 2Centre for Surgical Invenvtion and Innovation
Introduction: Bariatric surgery has been shown to lead to a significant improvement in glucose homeostasis, resulting in greater rates of remission of type 2 diabetes mellitus (T2DM). While there is a great amount of evidence of the benefits of metabolic surgery in patients on oral therapy for T2DM in obese patients, there is sparse evidence on the impact of bariatric surgery on insulin-treated type 2 diabetes (I-T2D) patients.
Methods: Analysis of the Ontario Bariatric Registry data was performed to compare the outcomes of gastric bypass (RYGB) and sleeve gastrectomy (VSG) on insulin treated patients versus non-insulin treated, type 2 diabetics. We compared weight loss, HbA1c levels, and medication use between the 2 groups during a three year follow up period post surgery. Descriptive statistics are used for all related variables.
Results: A total of 3270 type 2 diabetic patients underwent surgery between 2010 and 2015. Of these 2264 were on oral meds (O-T2D) and 1006 were insulin treated (I-T2D). The non-insulin RYGB group had the greatest mean weight loss at 1 year with 31.5 % (±8.3%), while the insulin RYGB group had greater mean weight loss at year 2 and 3 with 31.4% (±8.7%) and 30.9% (±10%). All mean weight loss was comparable at 3 years (p<.0001). HbA1c levels improved in all groups at 3 years, decreasing by 1.4% in the RYGB insulin group, 1.3% in the non-insulin groups, and 1.2% in the VSG insulin group. The 2 insulin groups had a higher HbA1c baseline mean (8.3% RYGB and 8.1% VSG) and did not reach a mean below 6.5% (both at 6.9% at 3 years). Anti-diabetes medication use reduced in all groups, with the highest reduction in the RYGB non-insulin group from 78% to 16.9% at 3 years. The non-insulin VSG group decreased medication use from 75% to 23%. The RYGB and VSG insulin groups reduced to 55% and 57% respectively.
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Conclusion: Bariatric surgery is effective for weight loss and control of diabetes for insulin-treated T2DM patients, with a greater weight loss associated with the RYGB procedure, although not clinically significant. Both RYGB and VSG procedures provide effective treatment for I-T2D patients in terms of weight loss and improvement in diabetes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80324
Program Number: S023
Presentation Session: Bariatric and Metabolic Surgery
Presentation Type: Podium