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Erschienen in: Obesity Surgery 1/2015

01.01.2015 | Original Contributions

Predicting Remission of Diabetes After RYGB Surgery Following Intensive Management to Optimize Preoperative Glucose Control

verfasst von: Thomas MacAndrew English, Samir Malkani, Rebecca L. Kinney, Abdulkadir Omer, Mary Beth Dziewietin, Richard Perugini

Erschienen in: Obesity Surgery | Ausgabe 1/2015

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Abstract

Background

The purpose of the study is to investigate the association of preoperative glucose optimization prior to a Roux-en-Y gastric bypass (RYGB) and diabetes remission.

Methods

The study is a retrospective review of 245 patients with a history of diabetes type II and a RYGB from 2008 to 2012 at UMass Memorial Hospital.

Results

Patients that benefited from glucose optimization prior to RYGB were more likely to achieve diabetes remission 1 year after surgery. The preoperative glucose optimization intervention demonstrated that when patients decreased their HbA1c prior to surgery by 1 %, these individuals were 68 % more likely to remit (p = 0.015). Duration of diabetes (p = 0.005) and insulin use (p < 0.001) were also significant predictors of remission, whereas age, race, and gender were not.

Conclusions

Our study results indicate that a greater degree of glycemic improvement in response to presurgical medical intervention is associated with higher rates of diabetes remission post-operatively among obese adults with diabetes type II. Conversely, the lack of favorable glycemic response to intensification of medical management predicts a poor glycemic response to bariatric surgery. Further research is needed to determine if this difference is due to physiological factors or is simply an indicator of patient behavior.
Literatur
1.
Zurück zum Zitat Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76. PMCID: 3372918.PubMedCentralPubMedCrossRef Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76. PMCID: 3372918.PubMedCentralPubMedCrossRef
2.
Zurück zum Zitat Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.PubMedCrossRef Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.PubMedCrossRef
3.
Zurück zum Zitat Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56. e5.PubMedCrossRef Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56. e5.PubMedCrossRef
4.
Zurück zum Zitat Hamza N, Abbas MH, Darwish A, et al. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis. 2011;7(6):691–6.PubMedCrossRef Hamza N, Abbas MH, Darwish A, et al. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis. 2011;7(6):691–6.PubMedCrossRef
5.
Zurück zum Zitat Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84. discussion 84-5. PMCID: 1360104.PubMedCentralPubMed Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84. discussion 84-5. PMCID: 1360104.PubMedCentralPubMed
6.
Zurück zum Zitat Dixon JB, Chuang LM, Chong K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6. PMCID: 3526207.PubMedCentralPubMedCrossRef Dixon JB, Chuang LM, Chong K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6. PMCID: 3526207.PubMedCentralPubMedCrossRef
7.
Zurück zum Zitat Huang CK, Shabbir A, Lo CH, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25-35. Obes Surg. 2011;21(9):1344–9. PMCID: 3157602.PubMedCentralPubMedCrossRef Huang CK, Shabbir A, Lo CH, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25-35. Obes Surg. 2011;21(9):1344–9. PMCID: 3157602.PubMedCentralPubMedCrossRef
8.
Zurück zum Zitat Lee WJ, Hur KY, Lakadawala M, et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg. 2012;16(1):45–51. discussion -2.PubMedCrossRef Lee WJ, Hur KY, Lakadawala M, et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg. 2012;16(1):45–51. discussion -2.PubMedCrossRef
9.
Zurück zum Zitat Still CD, Wood GC, Chu X, Manney C, Strodel W, Petrick A, et al. Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2013 Still CD, Wood GC, Chu X, Manney C, Strodel W, Petrick A, et al. Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2013
10.
Zurück zum Zitat Hayes MT, Hunt LA, Foo J, et al. A model for predicting the resolution of type 2 diabetes in severely obese subjects following Roux-en Y gastric bypass surgery. Obes Surg. 2011;21(7):910–6.PubMedCrossRef Hayes MT, Hunt LA, Foo J, et al. A model for predicting the resolution of type 2 diabetes in severely obese subjects following Roux-en Y gastric bypass surgery. Obes Surg. 2011;21(7):910–6.PubMedCrossRef
11.
Zurück zum Zitat Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus Intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus Intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014.
13.
Zurück zum Zitat Kashyap SR, Bhatt DL, Wolski K, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care. 2013;36(8):2175–82. PMCID: 3714483.PubMedCentralPubMedCrossRef Kashyap SR, Bhatt DL, Wolski K, et al. Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care. 2013;36(8):2175–82. PMCID: 3714483.PubMedCentralPubMedCrossRef
14.
Zurück zum Zitat Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9. PMCID: 3954742.PubMedCentralPubMedCrossRef Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9. PMCID: 3954742.PubMedCentralPubMedCrossRef
15.
Zurück zum Zitat Arterburn D, Bogart A, Coleman KJ, et al. Comparative effectiveness of bariatric surgery vs. nonsurgical treatment of type 2 diabetes among severely obese adults. Obes Res Clin Pract. 2013;7(4):e258–68.PubMedCrossRef Arterburn D, Bogart A, Coleman KJ, et al. Comparative effectiveness of bariatric surgery vs. nonsurgical treatment of type 2 diabetes among severely obese adults. Obes Res Clin Pract. 2013;7(4):e258–68.PubMedCrossRef
16.
Zurück zum Zitat Dirksen C, Jacobsen SH, Bojsen-Moller KN, et al. Reduction in cardiovascular risk factors and insulin dose, but no beta-cell regeneration 1 year after Roux-en-Y gastric bypass in an obese patient with type 1 diabetes: a case report. Obes Res Clin Pract. 2013;7(4):e269–74.PubMedCrossRef Dirksen C, Jacobsen SH, Bojsen-Moller KN, et al. Reduction in cardiovascular risk factors and insulin dose, but no beta-cell regeneration 1 year after Roux-en-Y gastric bypass in an obese patient with type 1 diabetes: a case report. Obes Res Clin Pract. 2013;7(4):e269–74.PubMedCrossRef
17.
Zurück zum Zitat Cheskin LJ, Kahan SACP, Club J. Review: bariatric surgery increases weight loss and diabetes remission more than nonsurgical treatment. Ann Intern Med. 2014;160(2):JC7.PubMedCrossRef Cheskin LJ, Kahan SACP, Club J. Review: bariatric surgery increases weight loss and diabetes remission more than nonsurgical treatment. Ann Intern Med. 2014;160(2):JC7.PubMedCrossRef
18.
Zurück zum Zitat Brandenburg D, Kotlowski R. Practice makes perfect? Patient response to a prebariatric surgery behavior modification program. Obes Surg. 2005;15(1):125–32.PubMedCrossRef Brandenburg D, Kotlowski R. Practice makes perfect? Patient response to a prebariatric surgery behavior modification program. Obes Surg. 2005;15(1):125–32.PubMedCrossRef
19.
Zurück zum Zitat Dolfing JG, Dubois EF, Wolffenbuttel BH, et al. Different cycle ergometer outcomes in severely obese men and women without documented cardiopulmonary morbidities before bariatric surgery. Chest. 2005;128(1):256–62.PubMedCrossRef Dolfing JG, Dubois EF, Wolffenbuttel BH, et al. Different cycle ergometer outcomes in severely obese men and women without documented cardiopulmonary morbidities before bariatric surgery. Chest. 2005;128(1):256–62.PubMedCrossRef
20.
Zurück zum Zitat Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):141–5. discussion 5-6.PubMedCrossRef Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):141–5. discussion 5-6.PubMedCrossRef
21.
Zurück zum Zitat Kalarchian MA, Marcus MD, Courcoulas AP, et al. Preoperative lifestyle intervention in bariatric surgery: initial results from a randomized, controlled trial. Obesity (Silver Spring). 2013;21(2):254–60. PMCID: 3610845.CrossRef Kalarchian MA, Marcus MD, Courcoulas AP, et al. Preoperative lifestyle intervention in bariatric surgery: initial results from a randomized, controlled trial. Obesity (Silver Spring). 2013;21(2):254–60. PMCID: 3610845.CrossRef
22.
Zurück zum Zitat Tarnoff M, Kaplan LM, Shikora S. An evidenced-based assessment of preoperative weight loss in bariatric surgery. Obes Surg. 2008;18(9):1059–61.PubMedCrossRef Tarnoff M, Kaplan LM, Shikora S. An evidenced-based assessment of preoperative weight loss in bariatric surgery. Obes Surg. 2008;18(9):1059–61.PubMedCrossRef
23.
Zurück zum Zitat Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.PubMedCrossRef Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.PubMedCrossRef
24.
Zurück zum Zitat Laferrere B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93(7):2479–85. PMCID: 2453054.PubMedCentralPubMedCrossRef Laferrere B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93(7):2479–85. PMCID: 2453054.PubMedCentralPubMedCrossRef
25.
Zurück zum Zitat Lingvay I, Guth E, Islam A, et al. Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery? Diabetes Care. 2013;36(9):2741–7. PMCID: 3747905.PubMedCentralPubMedCrossRef Lingvay I, Guth E, Islam A, et al. Rapid improvement in diabetes after gastric bypass surgery: is it the diet or surgery? Diabetes Care. 2013;36(9):2741–7. PMCID: 3747905.PubMedCentralPubMedCrossRef
26.
Zurück zum Zitat Campos GM, Rabl C, Peeva S, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg. 2010;14(1):15–23. PMCID: 2793380.PubMedCentralPubMedCrossRef Campos GM, Rabl C, Peeva S, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg. 2010;14(1):15–23. PMCID: 2793380.PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Lin E, Davis SS, Srinivasan J, et al. Dual mechanism for type-2 diabetes resolution after Roux-en-Y gastric bypass. Am Surg. 2009;75(6):498–502. discussion -3. PMCID: 3068861.PubMedCentralPubMed Lin E, Davis SS, Srinivasan J, et al. Dual mechanism for type-2 diabetes resolution after Roux-en-Y gastric bypass. Am Surg. 2009;75(6):498–502. discussion -3. PMCID: 3068861.PubMedCentralPubMed
Metadaten
Titel
Predicting Remission of Diabetes After RYGB Surgery Following Intensive Management to Optimize Preoperative Glucose Control
verfasst von
Thomas MacAndrew English
Samir Malkani
Rebecca L. Kinney
Abdulkadir Omer
Mary Beth Dziewietin
Richard Perugini
Publikationsdatum
01.01.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 1/2015
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1339-2

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