Andrew A Taitano, MD, Tejinder P Singh, MD. AMC Bariatric Surgery Group, Albany Medical Center
INTRODUCTION: The surgical treatment of morbid obesity leads to weight loss and remission of diabetes in most patients with type 2 diabetes mellitus (T2DM). However, little is known regarding whether patients who regain weight after surgery will maintain remission of their diabetes. Our purpose was to investigate the rate of remission of T2DM (defined as maintaining a normal hemoglobin A1C without the use of diabetes medication) and the association with factors such as weight loss and weight regain in patients after gastric bypass surgery.
METHODS: We evaluated pre- and post-operative data, including demographics, weight at all follow-up encounters, Hemoglobin A1C levels, and medication lists of patients undergoing laparoscopic roux-en-y gastric bypass (LRYGBP) between April 2003 and May 2009.
RESULTS: 344 Patients underwent LRYGBP, of whom 22.4% had T2DM. Follow-up was possible in 77.8% and averaged 3.1 years. Patients with T2DM achieved 74.5% excess BMI loss compared to 82.7% in patients without T2DM. Patients with T2DM experienced less weight regain than patients without T2DM (13.3% vs 19.5%). At last follow-up, 80.3% of patients with T2DM achieved remission and 91.8% of patients with T2DM experienced remission or improvement of their disease. Patients taking oral medications for T2DM were more likely to achieve remission than patients taking insulin or insulin and oral medications (91.3% vs 46.7%), RR 1.96 (1.13 to 3.39, 95% CI). Patients with greater than average weight loss did not achieve remission more frequently than patients with less than average weight loss (80.0% vs 80.5%). There was no statistical difference in rates of remission between patients who regained more weight compared to those who regained less weight (77.4% vs 83.3%). There was a trend towards higher rates of remission with higher BMI at the time of surgery (89.5% for BMI 50-70, 80% for BMI 40-50, and 66.7% for BMI 33-40), but these results did not achieve statistical significance.
CONCLUSIONS: LRYGBP resulted in significant maximum excess BMI loss (74.5%) and remission of T2DM (80.3%) at 3.1 years average follow-up. Remission rates were higher in patients taking oral medications for diabetes. There was a trend toward higher rates of remission with higher BMI at the time of surgery. Despite significant weight regain, patients with T2DM achieved high rates of remission.
Session Number: Poster – Poster Presentations
Program Number: P416