Diabetes remission after bariatric surgery: a 10-years follow-up study

Ines Meira; Joao Menino; Juliana Goncalves; Helena Ferreira; Leite Ana Rita; Patricia Ferreira; Sara Ribeiro; Telma Moreno; Diana Silva; Paula Freitas; da Costa Eduardo Lima; Joana Queiros

doi:10.1530/endoabs.99.P489

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Endocrine Abstracts (2024) 99 P489 | DOI: 10.1530/endoabs.99.P489

ECE2024 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (130 abstracts)

Diabetes remission after bariatric surgery: a 10-years follow-up study

Inês Meira ^1,2 , João Menino ^1,2 , Juliana Gonçalves ^1,2 , Helena Ferreira ^1,2 , Ana Rita Leite ^1,2 , Patricia Ferreira ¹ , Sara Ribeiro ^1,2 , Telma Moreno ^1,2 , Diana Silva ^1,2 , Paula Freitas ^2,3 , Eduardo Lima da Costa ³ , Joana Queirós ¹ & CRIO . ³

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¹São João Universitary Hospital Center, Porto, Portugal; ²Faculdade de Medicina da Universidade do Porto - FMUP, Porto, Portugal; ³CRIO –Centro Responsabilidade Integrada Obesidade., Porto, Portugal

Introduction: Although lifestyle measures and medical therapy are the cornerstone of type 2 diabetes (T2DM) management, achieving optimal glycemic control in T2DM patients with obesity remains challenging. There is strong and consistent evidence that bariatric surgery (BS) is an effective strategy to improve glycemia in diabetic patients and often leads to remission of T2DM in patients with obesity. The majority of the published literature supporting T2DM remission after BS has short- and medium-term follow-up. However, the durability of glycemic improvements and the potential for long-term "cure" in T2DM patients following BS remain insufficiently studied.

Aim: Determine the incidence of durable remission and relapse of T2DM rates 10 years after BS, characterize the glycemic profile of these patients after surgery, and identify factors predicting persistent remission of T2DM.

Methods: Retrospective observational study of patients with T2DM undergoing BS between 2010 and 2013. Exclusion criteria included patients undergoing gastric band surgery, those without initial and 10-year post-surgery HbA1c or fasting plasma glucose (FPG) determination, and those undergoing revisional surgery or deceased during the follow-up period. Paired t-tests, Wilcoxon signed rank and McNemar tests were used to assess the differences in the metabolic status during the follow-up, as appropriate. Logistic regression models were used to assess predictors of T2DM remission.

Results: Ninety-five patients were included, 84% of whom were women, with a mean age of 48.8±9.1 years and a mean HbA1c of 7.0±1.5%. Ten years after surgery, the rate of complete T2DM remission was 31%, partial remission was 15%, and late recurrence after initial remission was 24%. Patients with lower HbA1c (OR=0.50; P=0.05) and taking fewer antidiabetic drugs (OR=0.31; P=0.01) preoperatively were more likely to maintain long-term remission. The surgical technique used and the duration of T2DM did not reach statistical significance as predictors of remission in multivariate analysis. Patients with T2DM maintained reductions in FPG (P<0.001), HbA1c (P<0.001), number of antidiabetic drugs (P<0.001), and insulin use (P<0.001) ten years post-BS.

Conclusion: In conclusion, BS can induce a significant and sustainable remission and improvement of T2DM. Consistent with previous studies, our data suggests that when the main goal of surgical treatment is durable diabetes remission, earlier surgical intervention is likely to be more effective. Longer follow-up reports and prospective, randomized controlled studies are important to confirm these findings.