Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study

Autor: Reimar W. Thomsen, Lisbeth M. Baggesen, Lene Ring Madsen, Bjørn Richelsen
Rok vydání: 2018
Předmět:
0301 basic medicine
Male
Gastric bypass
Endocrinology
Diabetes and Metabolism
Denmark
Type 2 diabetes
medicine.disease_cause
0302 clinical medicine
Medicine
Diabetes remission
Macrovascular complications
education.field_of_study
Remission Induction
Middle Aged
Metformin
Treatment Outcome
Cohort
Female
Cohort study
medicine.drug
Adult
medicine.medical_specialty
Microvascular complications
Roux-en-Y gastric bypass
Population
Gastric Bypass
030209 endocrinology & metabolism
Lower risk
Diabetes Complications
03 medical and health sciences
Diabetes mellitus
Internal medicine
Internal Medicine
Humans
Hypoglycemic Agents
Obesity
education
Population-based study
Proportional Hazards Models
Glycated Hemoglobin
business.industry
Gastric bypass surgery
Microcirculation
nutritional and metabolic diseases
medicine.disease
030104 developmental biology
Diabetes Mellitus
Type 2
business
Follow-Up Studies
Zdroj: Madsen, L R, Baggesen, L M, Richelsen, B & Thomsen, R W 2019, ' Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study ', Diabetologia, vol. 62, no. 4, pp. 611-620 . https://doi.org/10.1007/s00125-019-4816-2
ISSN: 1432-0428
DOI: 10.1007/s00125-019-4816-2
Popis: AIMS/HYPOTHESIS: The aim of this study was to examine the effect of Roux-en-Y gastric bypass (RYGB) surgery on diabetes remission, subsequent diabetes relapse and micro- and macrovascular complications in individuals with type 2 diabetes and obesity (BMI >35 kg/m2) in a real-world setting.METHODS: This was a population-based cohort study of 1111 individuals with type 2 diabetes treated by RYGB at hospitals in Northern Denmark (2006-2015), and 1074 matched non-operated individuals with type 2 diabetes. Diabetes remission was defined as no glucose-lowering drug use with HbA1c RESULTS: At 1 year of follow-up, 74% of the cohort treated by RYGB experienced diabetes remission, while 27% had relapsed after 5 years. Predictors of non-remission were age >50 years, diabetes duration >5 years, use of glucose-lowering drugs other than metformin, and baseline HbA1c >53 mmol/mol (>7.0%). Compared with the non-operated cohort using adjusted Cox regression (5.3 years follow-up), the cohort treated by RYGB had 47% lower risk of microvascular complications (HR 0.53 [95% CI 0.38, 0.73]) and a statistically non-significant 24% lower risk of macrovascular complications (HR 0.76 [95% CI 0.49, 1.18]). Diabetes remission vs non-remission at 1 year was associated with reduced HR of 0.43 (95% CI 0.25, 0.72) for microvascular complications and with HR of 0.76 (95% CI 0.40, 1.45) for macrovascular complications.CONCLUSIONS/INTERPRETATION: In routine clinical care, three out of four individuals with type 2 diabetes and obesity treated by RYGB experienced diabetes remission after 1 year, whereas 27% of these individuals had relapsed at 5 years follow-up. RYGB was associated with substantially decreased risk of microvascular complications and non-significantly fewer macrovascular complications, with early diabetes remission as a clear predictor of reduced microvascular complications.
Databáze: OpenAIRE
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