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Diabetes and weight loss

Diabetes control and predictors of weight loss

The rate of remission was lower after LAGB 2.65 compared with gastric bypass and sleeve gastrectomy
Predictive factors of inadequate EWL include higher initial BMI, older age, presence of DM and preoperative weight gain

“Although bariatric surgery has been shown to improve diabetes control, there is limited large-scale long term data on the efficacy of this treatment,” said Omar Khan from the Whittington Hospital, Department of Surgery, London, UK, at the 6th Annual Meeting of the British Obesity and Metabolic Surgical Society 21-23 January, in Newcastle, UK. “Therefore, we undertook a study to evaluate the long-term efficacy of bariatric surgical procedures on metabolic control of obese patients with type 2 diabetes."

Khan and colleagues used primary care electronic health records from the UK Clinical Practice Research Datalink and 803 obese participants with type 2 diabetes who received bariatric surgery (ie adjustable gastric banding (LAGB), gastric bypass (GBP) or sleeve gastrectomy (SG)) from 2002 to 2014 were selected. Non-surgical control participants were matched for age, sex, BMI and index year. HbA1c records and diabetes prescriptions were evaluated for up to seven years after operation. Participants were classified as in remission if HbA1c <6.5% and no diabetes prescriptions were received within one year.

Omar Khan

From the 803 obese diabetic participants who received bariatric surgery (LAGB-214; GBP- 439; and SG- 147; with three procedures undefined), they reported that the mean HbA1c declined from 8.0% before BS to 6.5% in the second postoperative year. The proportion of patients with a HbA1c <6.5% increased from 17% to 47%; and the proportion receiving no diabetes prescriptions increased from 15% to 55%. The adjusted relative rate of diabetes remission after bariatric surgery as compared with controls was 4.45 (p<0.001). However, the rate of remission was lower after LAGB 2.65 (1.83-3.83) as compared with gastric bypass (4.91(3.76-6.42) and sleeve gastrectomy 5.78 (4.21-7.94)).

“Bariatric surgery is associated with better metabolic control and lower diabetes drug utilisation up to seven years after the procedure as compared with control subjects<” added Khan. “LAGB may be less effective than gastric bypass or sleeve gastrectomy.”

Co-author of the study were Helen Booth2, Marcus Reddy4, Toby Prevost2, Alex Dregan2, Judith Charlton4, Mark Ashworth2, Caroline Rudisill5, Peter Littlejohns2, Martin Gulliford1 (1Whittington Hospital, Department of Surgery, London, UK, 2King’s College London, Department of Primary Care and Public Health Sciences, London, UK, 3Guy’s and St Thomas’ NHS Foundation Trust, NIHR Biomedical Research Centre, London, UK, 4St George’s Hospital, Department of Surgery, London, UK, 5London School of Economics and Political Science, Department of Social Policy, London, UK)

Predictors of inadequate excess weight

Although it is well document that laparoscopic Roux en-Y gastric bypass (LRYGB) is an effective treatment for morbid obesity resulting in approximately 70% excess weight loss (EWL) at two-years, Waleed Al-Khyatt and colleagues from the Royal Derby Hospital, Derby, UK, sought to identify factors predictive of inadequate EWL following primary LRYGB.

They collected prospective data on consecutive patients who underwent primary LRYGB between September 2009 and March 2013. The effects of age, gender, baseline body mass index BMI, preoperative EWL, length of time between initial consultation and surgery (TtS), presence of diabetes mellitus (DM), arthritis, obstructive sleep apnoea (OSA), and postoperative length of hospital stay (LOS) on EWL at 12- months were studied.

General linear regression models were used to evaluate group differences in EWL and to assess independent associations between baseline variables and EWL at 12-months. Stepwise regression analyses were used to estimate individual contributions of independent variables to the variance in EWL at 12-months. In this study, inadequate EWL was defined as <50% EWL at 12-months.


Waleed Al-Khyatt

They reported that LRYGB was performed in 227 patients with a mean±SD age and BMI of 48.6±11 years and 53.6±7.1, respectively, with over 70% of patients female. EWL at 12-months had an inverse correlation with age (p=0.01), baseline BMI (p<0.001), TtS (p=0.001), OSA (p=0.039) and DM (p=0.039). Conversely, there was a significant positive association between preoperative EWL and that at 12-months (p=0.009). There was no effect of gender, arthritis, or LOS on EWL at 12-months. 

Multiple regression analysis demonstrated inadequate EWL at 12-months to be predicted by older age (>60 years), patients with diabetes, higher baseline BMI (>60), those who gained weight preoperatively and in patients who waited longer than 18-months for surgery (p=0.027).

“Preoperative factors that predict inadequate EWL at 12- months following primary LRYGB include higher initial BMI, older age, presence of DM, and preoperative weight gain,” Identification of these factors preoperatively should aid in counselling these patients.

Co-authors of this study were Rebecca Ryall, Sherif Awad and Javed Ahmed Royal Derby Hospital, Derby, UK

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