What Leads to Patients With Diabetes Relapsing After Bariatric Surgery?
Most patients with morbid obesity and type 2 diabetes (T2D) who underwent weight loss surgery achieved remission from the latter, but relapse was still an issue for some, a researcher reported. In a retrospective, registry-based study with a median of 5.9 years, 20.1% of the patients experienced T2D relapse and required T2D retreatment, according to Erik Stenberg, MD, PhD, of rebro University in Sweden. And men were less likely to experience T2D relapse versus women, he said in a presentation at the American Society for Metabolic & Bariatric Surgery (ASMBS) virtual meeting. Specifically, men in the study had a reduced risk of T2D relapse after undergoing either a sleeve gastrectomy or Roux-en-Y gastric bypass (HR 0.65, 95% CI 0.46-0.91, P=0.012), according to Stenberg and colleagues. They also reported that the following risk factors were associated with T2D relapse:  Longer duration of diabetes: HR 1.09 (95% CI 1.05-1.14, P<0.001)  Higher than average preoperative HbA1c level: HR 1.01 (95% CI 1.00-1.02, P=0.013)  Preoperative insulin treatment: HR 2.67 (95% CI 1.84-3.90, P<0.001)  Less postoperative weight loss: HR 0.93 (95% CI 0.91-0.96, P<0.001)  Stenberg and colleagues included all adult patients with T2D and a BMI of at least 35, who underwent primary bariatric surgery in Sweden between 2007 and 2015, and achieved complete diabetes remission 2 years after surgery. The main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication. He reported that complete remission of T2D was achieved by 2,090 patients 2 years after surgery. The mean age was 46.6, the mean BMI at the time of operation was 42.7, and mean HbA1c at the time of surgery was 54.8 mmol/mol. Mitchell Roslin, MD, of Lenox Hill Hospital in New York City, told MedPage Today that the type of surgery may impact whether a patient remains in T2D remission. "With the SADI-S -- a single anastomosis duodenal switch -- resolution of diabetes approached 90%," he explained. Roslin, who was not involved in the current study, helped develop the SADI-S procedure. "With Roux-en-Y gastric bypass, the remission rate is around 50%, assuming the definition of remission is an HbA1c of less that 6% without medication. Sleeve gastrectomy approaches bypass, but falls off several years after surgery. Additionally, because glucose variability is lower in SADI-S, recurrence of diabetes is much lower," Roslin said. "Recurrence is going to be highest with sleeve gastrectomy and lowest in duodenal switch type procedures. The [T2D] resolution can last indefinitely," he stated, adding that "Weight regain and change in eating behavior will increase chance of recurrence. The long-term rates will tend to vary with the type of surgery that was performed." Ed Susman is a freelance medical writer based in Fort Pierce, Florida, USA.