High GDI best indicator of diabetes remission after bypass

Pancreatic function, and not initial BMI, is the best indicator of diabetes remission after Roux en Y gastric bypass, according to a new study presented at the ASMBS’ 29th Annual Meeting.

The study, ‘Predictors for Remissions of Type 2 Diabetes Mellitus Following Roux En Y Gastric Bypass’, found that 67% of gastric bypass patients achieved diabetes remission one year after surgery, but that number grew to more than 96% if patients were not already on insulin and did not have reduced pancreatic function as measured by the glucose disposition index (GDI).

If GDI was 30% of normal, patients were less likely to achieve remission.

The study also found that neither patient’s initial weight before surgery, nor weight loss both after six weeks and one year, had no impact on remission rates.

“The study shows beta cell function, the cells in the pancreas that produce insulin, and insulin dependence, not initial weight or subsequent weight loss, are the greatest predictors of potential diabetes remission after gastric bypass,” said Richard A. Perugini, MD, a bariatric surgeon at University of Massachusetts Medical Center in Worcester and lead study author.

“The study further confirms type 2 diabetes becomes more difficult to manage as it progresses.”

The study included 139 gastric bypass patients aged 48 to 57, with BMIs ranging from 33 to 75. All required medication to manage their type 2 diabetes.

36% of patients no longer needed diabetic medication within two weeks of surgery, rising to 46% at six weeks, 57% at six months and 67% after one year.

However, over 96% of patients on diabetes medications other than insulin and with a GDI that had not fallen below 30 percent of normal achieved remission.

All patients’ HbA1c levels fell from an average of 6.9% to 6.1% over the period of the study. Patients achieved an average of 59% EWL and 15 BMI points after one year.

Co-authors for the study included John J. Kelly, MD, Philip Cohen, MD, Donald R. Czerniach, MD and Karen A. Gallagher-Dorval, RN.