Components figuring out probability of kind 2 diabetes remission after Roux-en-Y gastric bypass surgical procedure: a nationwide cohort research in 8057 Swedish sufferers

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BMJ Open Diabetes Res Care. 2021 May; 9 (1): e002033. doi: 10.1136 / bmjdrc-2020-002033.

ABSTRACT

INTRODUCTION: Bariatric and metabolic surgery is an effective treatment option for type 2 diabetes (T2D). A better knowledge of factors associated with diabetes remission is essential in individual decision-making and could guide post-operative care. Therefore, we wanted to investigate factors known to affect the likelihood of diabetes remission after bariatric and metabolic surgery, and further investigate the effects of socio-economic factors.

RESEARCH DESIGN AND METHODS: In this nationwide study, we examined all patients with T2D who underwent Roux-en-Y gastric bypass surgery (RYGB) between 2007 and 2015 in the Scandinavian Obesity Surgery Register. Remission was defined as the absence of antidiabetic drugs for T2D 2 years after surgery. Multivariable logistic regression was used to assess the factors associated with diabetes remission, processing missing data from multiple imputations.

Results: A total of 8057 patients were included. The mean age ± SD was 47.4 ± 10.1 years, the mean body mass index 42.2 ± 5.7 kg / m2, the mean hemoglobin A1c 59.0 ± 17.33 and 61.7% ( n = 4970) were women. Two years after surgery, 6,211 (77.1%) patients achieved T2D remission. Preoperative insulin treatment (OR 0.26, 95% CI 0.22 to 0.30), first generation immigrants (OR 0.66, 95% CI 0.57 to 0.77), duration of T2D (OR 0.89 , 95% CI 0.88 to 0.90), dyslipidemia (OR 0.71) 95% CI 0.62 to 0.81), age (OR 0.97, 95% CI 0.96 to 0.97) and highly glycosylated hemoglobin A1c (HbA1c) (OR 0.99, 95% CI 0.98 to 0.99) were all associated with a lower T2D remission rate. In contrast, residing in a medium (OR 1.39, 95% CI 1.20 to 1.61) or small (OR 1.46, 95% CI 1.25 to 1.71) city and percentage of total weight loss ( OR 1.04, 95% CI 1.03 to 1.04)) were associated with higher remission rates.

CONCLUSION: In patients with T2D undergoing RYGB surgery, increasing age, HbA1c, and duration of diabetes decreased the likelihood of achieving diabetes remission without cut-offs, while postoperative weight loss showed a positive linear association. Being a first generation immigrant living in a big city were socio-economic factors that were negatively related.

PMID: 33990366 | DOI: 10.1136 / bmjdrc-2020-002033