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T2D remission

Study shows T2D remission six-years after surgery

34% had significant improvements in glycaemic control

Fifty three percent of patients with previous type 2 diabetes mellitus were in complete or partial remission six years after bariatric surgery, according to the results from single centre study, ‘Can Diabetes Be Surgically Cured? Long Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus’, presented at the American Surgical Association meeting in Indianapolis.

The researchers from the Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, assessed the metabolic parameters and clinical outcomes of 150 patients with type 2 diabetes who underwent bariatric surgery during 2004-2007 and had at least five-year follow-up.

Complete remission was defined as glycated haemoglobin (HbA1c) <6% and fasting glucose (FBG)<100mg/dL off diabetic medications, and partial remission was defined as an HbA1c between 6% and 6.4% and a fasting blood glucose between 100 and 125 mg/dL for at least a full year without anti-diabetic drugs.

The majority had gastric bypass surgery (n=107), but some patients also had gastric banding (n=28) or sleeve gastrectomy (n=15). At a median follow-up of six years (range 5-8) a mean excess weight loss of 43% was associated with a mean reduction in HbA1c and FBG of 1.1% and 43.6mg/dL, respectively.

Long-term complete and partial remission rate was 28% and 25%, respectively. Longer duration of T2D (p<0.001), higher preoperative HbA1c (p=0.001), surgeries other than bypass (p<0.001), and lower long-term EWL (p=0.001) predicted lack of complete remission.

Long-term recurrence of T2D after initial remission occurred in 14 patients (16%) and was associated with less EWL (p=0.007). Remission/improvement rate for co-existing dyslipidemia and hypertension was 53% and 69%, respectively.

Thirty four percent of patients had significant improvements in glycaemic control after six years, although they did not meet the criteria for continued remission. Sixteen percent of patients had glycaemic control that was unchanged or worse than recorded at baseline.

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