Long-term diabetic response to gastric bypass
| Autor: | Jimmy T. Efird, Stephen W. Davies, Peter T. Hallowell, Bruce D. Schirmer, Robert G. Sawyer, Christopher A. Guidry, Rachel I. Penn |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Gastric Bypass Article Diabetes Complications Weight loss Diabetes mellitus Internal medicine Weight Loss medicine Humans Retrospective Studies business.industry Insulin Incidence (epidemiology) Retrospective cohort study Middle Aged medicine.disease Confidence interval Obesity Morbid Surgery Current Procedural Terminology Female medicine.symptom business Body mass index Follow-Up Studies |
| Zdroj: | Journal of Surgical Research. 190:498-503 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2014.01.047 |
| Popis: | As obesity and type II diabetes continue to rise, bariatric surgery offers a solution, but few long-term studies are available. The purpose of this study was to evaluate the long-term outcomes of diabetic patients after gastric bypass.This was a retrospective cohort study of all diabetic patients undergoing gastric bypass at our institution, from 1998 to 2012. Patients were compared by postoperative diabetic response to treatment (i.e., response = off oral medication/insulin versus refractory = on oral medication/insulin) and followed at 1-, 3-, 5-, and 10-y intervals. Continuous data were analyzed using Student t-test or Wilcoxon rank-sum test. Multivariable, Cox proportional hazard regression model was performed to compute diabetic cure ratios and 95% confidence intervals.A total of 2454 bariatric surgeries were performed at our institution during the time period. A total of 707 diabetic patients were selected by Current Procedural Terminology codes for gastric bypass. Mean follow-up was 2.1 y. Incidence of diabetic response was 56% (1 y), 58% (3 y), 60% (5 y), and 44% (10 y). Postoperatively, responsive patients experienced greater percentage of total body weight loss (1 y [P 0.0001], 3 y [P = 0.0087], and 5 y [P = 0.013]), and less hemoglobin A1c levels (1 y [P = 0.035] and 3 y [P = 0.040]) at follow-up than refractory patients. Multivariable analysis revealed a significant, independent inverse trend in incidence of diabetic cure as both age and body mass index decreased (Ptrend = 0.0019 and0.0001, respectively). In addition, degenerative joint disease was independently associated with responsive diabetes (cure ratio = 1.6 [95% confidence interval = 1.1-2.2]).At follow-up, both groups in our study experienced substantial weight loss; however, a greater loss was observed among the response group. Further research is needed to evaluate methods for optimizing patient care preoperatively and improving patient follow-up. |
| Databáze: | OpenAIRE |
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