Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery
| Autor: | Bernardo M. Pessoa, Luke G. Wolfe, Guilherme M. Campos, Guilherme S. Mazzini, Matthew G. Browning, Amy Kaplan, Jad Khoraki |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Sleeve gastrectomy endocrine system diseases medicine.medical_treatment Gastric Bypass Type 2 diabetes medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Recurrence Weight loss Interquartile range Internal medicine Diabetes mellitus medicine Humans Longitudinal Studies Retrospective Studies Gastric bypass surgery business.industry Remission Induction nutritional and metabolic diseases Retrospective cohort study Middle Aged medicine.disease Obesity Morbid Diabetes Mellitus Type 2 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Surgery medicine.symptom business Body mass index |
| Zdroj: | Journal of the American College of Surgeons. 230:7-16 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2019.09.012 |
| Popis: | Background Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Roux-en-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. Study Design We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c Results Six hundred and twenty-one patients (aged 46.7 ± 10.6 years; 30% on insulin; BMI 49.8 ± 8.3 kg/m2) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse. Conclusions This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission. |
| Databáze: | OpenAIRE |
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