Endocrine Abstracts (2013) 32 P774 | DOI: 10.1530/endoabs.32.P774

Diabetes remission after bariatric surgery may be jeopardized by remission criteria and previous hypoglycemic treatment

Ana Ramos-Levi1, Andres Sanchez-Pernaute2, Lucio Cabrerizo1, Pilar Matia1, Ana Barabash1, 1Carmen Hernandez1,2, Alfonso Calle-Pascual1, Antonio Torres2 & Miguel Rubio1

1Department of Endocrinology and Nutrition, IdISSC, Hospital Clinico San Carlos, Madrid, Spain; 2Department of Surgery, IdISSC, Hospital Clinico San Carlos, Madrid, Spain.

Introduction: Controversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients’ baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin use.

Materials and methods: Retrospective study from a cohort of 657 BS performed in a single centre (2006–2011) of which 141 (57.4% women) had T2D. Evaluation of anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. Definition of T2D remission according to Buse et al: HbA1c <6%, fasting glucose (FG) <100 mg/dl, absence of pharmacologic treatment. Analysis of diabetes remission according to previous treatment.

Results: Preoperatively (mean ± S.D.): age 53.9±9.8 years, BMI 43.7±5.6 kg/m2, T2D duration 7.4±7.6 years, FG 160.0±54.6 mg/dl, HbA1c 7.6±1.6%. 56 (39.7%) individuals had insulin therapy (IT). At 1-year follow-up, 74 (52.5%) patients had diabetes remission. %WL, %EWL and preoperative C-peptide levels were associated to remission (35.5±8.1 vs 30.2±9.5%, P=0,001; 73.6±18.4 vs 66.3±22.8%, P=0.037, 4.9±2.1 vs 3.0±1.8 ng/ml, P=0.001 respectively). Duration of diabetes, age and female sex were associated to non-remission: 10.3±9.4 vs 4.7±3.8 years, P=0.000; 55.1±9.3 vs 51.2±9.9 years, P=0.017; 58.9 vs 33.3%, P=0.004 respectively. Prior treatment revealed differences in remission rates: 67.1% in case of oral therapy (OT) vs 30.4% in IT, P=0.000. After adjusting remission rates to OT/IT, differences in duration of diabetes persisted.

Conclusions: Buse criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission. Longer diabetes duration, lower %WL, %EWL and baseline C-peptide, higher age and female sex were associated to non-remission.