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Abi Mosleh K, Salameh Y, Ghusn W, Jawhar N, Mundi MS, Collazo-Clavell ML, Kendrick ML, Ghanem OM. Impact of metabolic and bariatric surgery on weight loss and insulin requirements in type 1 and insulin-treated type 2 diabetes. Clin Obes 2024:e12689. [PMID: 38934261 DOI: 10.1111/cob.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
Metabolic and Bariatric Surgery (MBS) is effective in improving metabolic outcomes and reducing weight in patients with obesity and diabetes, with less explored benefits in type 1 diabetes (T1D). This study aimed to evaluate the impact of MBS on weight loss and insulin requirements in T1D patients compared to insulin-treated type 2 diabetes (T2D) patients over a 5-year period. This retrospective analysis included patients who underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with a confirmed preoperative diagnosis of either T1D or insulin-treated T2D. Primary endpoints focusing on weight loss and secondary outcomes assessing changes in insulin dosage and glycemic control. After 5 years, weight loss was similar across groups, with total weight loss at 14.2% for T1D and 17.6% for insulin-treated T2D in SG, and 22.6% for T1D vs. 26.8% for insulin-treated T2D in RYGB. Additionally, there was a significant reduction in median daily insulin doses from 140.5 units at baseline to 77.5 units at 1 year postoperatively, sustained at 90 units at 5 years. The differential impact of MBS procedure was also highlighted, where RYGB patients showed a more pronounced and enduring decrease in insulin requirements compared to SG.
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Affiliation(s)
| | - Yara Salameh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wissam Ghusn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria L Collazo-Clavell
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Kim MK, Kim HS. Strategies to Maintain the Remission of Diabetes Following Metabolic Surgery. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2023; 12:26-34. [PMID: 38196781 PMCID: PMC10771975 DOI: 10.17476/jmbs.2023.12.2.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024]
Abstract
Obesity is a major risk factor for type 2 diabetes mellitus (T2DM). Bariatric surgery is the most effective means of inducing weight loss, and can ameliorate or induce the remission of obesity-related metabolic comorbidities, including T2DM. The guidelines for the management of T2DM emphasize weight management and recommend metabolic surgery for the treatment of T2DM accompanied by obesity. However, despite the clear beneficial effects of metabolic surgery, only 20-50% of patients who experience remission will stay in remission over the long term. Moreover, the beneficial effects of metabolic surgery tend to diminish with time, and a subset of patients experience a relapse of their diabetes. Therefore, in the present review, we discuss potential strategies for the maintenance of diabetic remission following metabolic surgery.
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Affiliation(s)
- Mi Kyung Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
- Center of Bariatric and Metabolic Surgery, Keimyung University, Dongsan Hospital, Daegu, Korea
| | - Hye Soon Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Hospital, Daegu, Korea
- Center of Bariatric and Metabolic Surgery, Keimyung University, Dongsan Hospital, Daegu, Korea
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Singh P, Adderley NJ, Subramanian A, Gokhale K, Hazlehurst J, Singhal R, Bellary S, Tahrani AA, Nirantharakumar K. Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom. Surg Obes Relat Dis 2022; 18:1366-1376. [PMID: 36123295 DOI: 10.1016/j.soard.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/30/2022] [Accepted: 08/01/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clinical trials have shown that bariatric surgery (BS) is associated with better glycemic control and diabetes remission in patients with type 2 diabetes (T2D) compared with routine care. OBJECTIVE We conducted a real-world population-based study examining the impact of BS on glycemic control and medications in patients with T2D. SETTING AND METHODS This was a retrospective, matched, controlled cohort study conducted between January 1, 1990, and January 31, 2018, using IQVIA Medical Research Data, a primary care electronic records database. Adults with body mass index (BMI) ≥30 kg/m2 and T2D who had BS (surgical) were matched for age, sex, BMI, and diabetes duration to two controls (with T2D and no BS). RESULTS A total of 1126 patients in the surgical group and 2219 patients in the control group were analyzed. Mean (standard deviation) age was 50.0 (9.3) years, 67.6% were women, baseline glycocylated hemoglobin (HbA1C) was 7.8% (1.7 mmol/mol), and diabetes duration was 4.7 years (range, 2.0-8.4 years). Over a median (interquartile range) follow-up of 3.6 years (1.7-5.9 years), a higher proportion of patients in the surgical group achieved an HbA1C of ≤6.0% than the control group (65.8% versus 22.8%). The surgical group showed a decrease in mean HbA1C of 1.5% (95% confidence interval [CI]: 1.4%-1.7%), 1.4% (1.2%-1.5%), and 1.3% (1.1%-1.5%) at 1-, 2-, and 3-year follow-up, respectively, whereas HbA1C increased in the control group. The proportion of patients receiving glucose-lowering medications decreased in the surgical group (92.2% to 66.5%) but increased in the control group (85.3% to 90.2%). CONCLUSION BS is associated with significant improvement in glycemic control, achievement of normal HbA1C levels, and reduced need for glucose-lowering therapy in patients with T2D.
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Affiliation(s)
- Pushpa Singh
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Hazlehurst
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rishi Singhal
- Department of Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - Srikanth Bellary
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Krishnarajah Nirantharakumar
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; Midlands Health Data Research, Birmingham, United Kingdom.
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Comment on: Retrospective Comparative Study of the Effectiveness of Bariatric Surgery on Three-Year Outcomes in the Real-World Clinical Setting. Surg Obes Relat Dis 2022; 18:e23-e24. [DOI: 10.1016/j.soard.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/20/2022]
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