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T2DM duration and remission

Association between pre-op T2DM duration and post-op remission

Five years after surgery, the chance of achieving complete remission was less the longer the pre-operative duration of diabetes (p<0.001)

The relationship between pre-operative diabetes duration and chance of T2DM remission is valuable in analysing the potential benefit compared to risk related to bariatric surgery, and can therefore be used to prioritise surgery for those patients who are most likely to achieve diabetes remission, according to researchers from Sweden.

The paper, ‘Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007–2015: A registry-based cohort study’, published in PLOS Medicine, sought to investigate the association between T2DM duration and the chance of achieving remission of T2DM after bariatric surgery. Complete remission of diabetes was defined as a HbA1c <42mmol/mol (6.0%) without medical treatment, partial remission as HbA1c 42–48mmol/mol (6.0%–6.5%) without medical treatment and controlled diabetes was defined as HbA1c <48mmol/mol (<6.5%) with medical treatment.

Utilising prospectively collected data from the Scandinavian Obesity Surgery Registry (SOReg), they identified 5,388 patients who were available for analyses on pharmaceutical use at five years. HbA1c was available at two years for 3,594 patients (42% of patients reaching the two-year follow-up) and at five years for 1,460 patients (27% of patients reaching the five-year follow-up). Follow-up data on day 30 were available for 8,448 patients (99% of all patients).

Five years after surgery, 1,623 patients (30.1%) received pharmacological treatment for diabetes: 1,095 received oral medical treatment alone for diabetes (20.3%), 152 received insulin alone (3.0%), 24 received a GLP-1 analogue alone (0.4%) and 342 received a combination of oral treatment and insulin (6.4%). The remaining 3,765 did not receive medical treatment for diabetes five years after surgery (69.9%). The chance of being free of diabetes medication five years after surgery was less with longer preoperative duration of diabetes (p<0.001).

Five years after surgery, 681 patients had complete remission of their diabetes (46.6%), 175 patients had partial remission (12.0%), 188 had controlled diabetes on medication (12.9%) and 416 patients (28.5%) still had a HbA1c > 48 mmol/mol on pharmacological treatment (Figure 1). The chance of achieving complete remission was less the longer the pre-operative duration of diabetes (p<0.001).

Figure 1: Stacked histogram of 5-year remission in relation to duration of diabetes

From the multivariable analysis examining the pre-operative factors potentially influencing diabetes remission - longer duration of diabetes, higher baseline HbA1c, older age and insulin treatment were all associated with lower remission rates two years after surgery. Higher BMI, higher excess BMI loss, and male sex in patients with T2DM were associated with higher remission rates.

As with previous studies, gastric bypass appeared to be associated with higher rates of T2DM remission than sleeve gastrectomy (in the unadjusted analysis), although the researchers cautioned that the study was not designed to compare the efficacy of the two procedures.

“In the present study, HbA1c values were only available for 27% of patients at the five-year follow-up, limiting analysis of long-term complete remission. However, the patterns of pharmaceutical usage and complete remission were very similar at the two-year and five-year follow-ups after surgery, consistent with previous studies,” the researchers concluded. “Remission of T2DM after bariatric surgery is negatively correlated to diabetes duration, with the highest rates among patients with more recent onset and less severe disease.”

To access this paper, please click here

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