Introduction
Methods
Patient Recruitment
-
Taiwan citizens, aged 20–67 years
-
Type 2 diabetes treated in a diabetes center for more than 6 months
-
BMI 25 kg/m2
-
Cancer in the past 5 years
-
Previous bariatric surgery
-
Body mass index (BMI) > 60 kg/m2
-
Significant T2DM complications including blindness, amputation (including any part of the body), chronic kidney disease (serum creatinine > 2 mg/ml), dialysis, major adverse cardiovascular events, and stroke
-
Unstable psychiatric illnesses
-
Refusal to give consent or adhere to follow-up
Data Collection
Statistical Analysis
Results
Participant Characteristics
Medical therapy | Bariatric surgery | P value | |||
---|---|---|---|---|---|
Number | 338 | 49 | |||
Variable | Mean | SD | Mean | SD | |
Age (year) | 51.12 | 9.64 | 44.94 | 11.01 | < 0.001 |
Gender (male %) | 62.72 | 40.82 | 0.005 | ||
Duration of diabetes (year) | 8.72 | 5.55 | 7.02 | 4.81 | 0.036 |
Weight (kg) | 81.94 | 12.52 | 95.88 | 20.63 | < 0.001 |
Waist circumference (cm) | 99.59 | 10.01 | 112.67 | 15.04 | < 0.001 |
Body mass index (kg/m2) | 30.02 | 3.93 | 36.11 | 6.90 | < 0.001 |
HbA1c (%) * | 7.91 | 1.40 | 8.80 | 1.53 | < 0.001 |
Fasting glucose (mg/dL)* | 155.91 | 47.13 | 181.67 | 63.17 | 0.016 |
LDL cholesterol (mg/dL) | 95.95 | 25.39 | 106.98 | 35.52 | 0.040 |
HDL cholesterol (mg/dL) | 41.60 | 8.93 | 40.86 | 9.39 | 0.59 |
Triglycerides (mg/dL)* | 181.24 | 126.38 | 294.86 | 295.87 | < 0.001 |
Systolic blood pressure (mmHg) | 133.52 | 13.64 | 135.64 | 13.70 | 0.31 |
Diastolic blood pressure (mmHg) | 83.23 | 10.19 | 83.04 | 7.64 | 0.88 |
Creatinine (mg/dL)* | 0.87 | 0.22 | 0.87 | 0.31 | 0.18 |
Urine albumin–creatinine ratio (mg/g)* | 119.0 | 415.0 | 538.8 | 2836.1 | 0.001 |
eGFR-MDRD (mL/min/1.73 m2) | 88.69 | 20.94 | 87.95 | 22.41 | 0.82 |
eGFR-CKD EPI (mL/min/1.73 m2) | 93.05 | 17.96 | 95.16 | 22.42 | 0.53 |
Pulse (/min) | 81.26 | 10.94 | 88.24 | 11.27 | < 0.001 |
Toe tuning fork score, right | 6.87 | 1.01 | 7.01 | 0.84 | 0.50 |
Toe tuning fork score, left | 6.84 | 0.97 | 7.05 | 0.83 | 0.32 |
Ankle reflex score, right (0, 0.5, 1)* | 0.03 | 0.12 | 0.07 | 0.23 | 0.19 |
Ankle reflex score, left (0, 0.5, 1)* | 0.03 | 0.12 | 0.07 | 0.23 | 0.19 |
10-g monofilament score, right* | 0.01 | 0.05 | 0.00 | 0.00 | 0.44 |
10-g monofilament score, left* | 0.00 | 0.05 | 0.00 | 0.00 | 0.51 |
Visual acuity, right* | 0.77 | 0.27 | 0.76 | 0.34 | 0.47 |
Visual acuity, left* | 0.79 | 0.26 | 0.81 | 0.32 | 0.14 |
Non-proliferative retinopathy, right | 0.14 | 0.35 | 0.10 | 0.31 | 0.47 |
Non-proliferative retinopathy, left | 0.13 | 0.34 | 0.10 | 0.31 | 0.58 |
Proliferative retinopathy, right | 0.02 | 0.15 | 0.04 | 0.20 | 0.56 |
Proliferative retinopathy, left | 0.02 | 0.15 | 0.04 | 0.20 | 0.56 |
All retinopathy | 0.32 | 0.71 | 0.29 | 0.71 | 0.64 |
Metformin | 0.85 | 0.20 | < 0.001 | ||
Sulfonylurea | 0.60 | 0.082 | < 0.001 | ||
Glitazone | 0.15 | 0.04 | 0.38 | ||
DPP4 inhibitor | 0.44 | 0.082 | < 0.001 | ||
Thiazolidinedione | 0.12 | 0.0 | 0.002 | ||
GLP-1 analogues | 0.023 | 0.0 | 0.36 | ||
α-glucosidase inhibitor | 0.015 | 0.0 | 0.51 | ||
Insulin | 0.22 | 0.061 | 0.004 | ||
ACE inhibitor /ARB | 0.47 | 0.10 | < 0.001 | ||
Other anti-hypertensives | 0.27 | 0.20 | 0.32 | ||
Statins | 0.56 | 0.24 | < 0.001 | ||
Anti-platelet therapy | 0.059 | 0.061 | 0.58 |
Renal, Neurological, and Ophthalmological Outcomes Between Standard Medical Treatment Group and Bariatric Surgery Group
Medical therapy | Bariatric surgery | |||||
---|---|---|---|---|---|---|
Number | 338 | 49 | P | P** | ||
Variable | Mean | SD | Mean | SD | ||
Change of weight (kg) | − 0.78 | 5.23 | − 24.50 | 17.31 | < 0.001 | < 0.001 |
Change of waist circumference (cm) | − 0.34 | 6.52 | − 21.59 | 12.40 | < 0.001 | < 0.001 |
Change of Body mass index (kg/m2) | − 0.33 | 1.79 | − 9.22 | 4.43 | < 0.001 | < 0.001 |
Change of HbA1c (%)* | − 0.35 | 1.24 | − 2.88 | 1.52 | < 0.001 | < 0.001 |
Change of fasting glucose (mg/dL)* | − 10.75 | 55.82 | − 75.57 | 66.70 | < 0.001 | < 0.001 |
Change of LDL cholesterol (mg/dL) | − 2.27 | 25.48 | − 12.91 | 50.17 | 0.1 | 0.013 |
Change of HLD cholesterol (mg/dL) | 1.83 | 20.75 | 11.49 | 11.05 | < 0.001 | 0.004 |
Change of triglycerides (mg/dL)* | − 5.07 | 132.47 | − 187.9 | 271.73 | < 0.001 | < 0.001 |
Change of systolic blood pressure (mmHg) | − 1.00 | 15.34 | − 19.10 | 29.56 | < 0.001 | < 0.001 |
Change of diastolic blood pressure (mmHg) | − 3.99 | 10.32 | − 12.78 | 17.50 | 0.001 | < 0.001 |
Change of creatinine (mg/dL)* | 0.54 | 6.64 | − 0.07 | 0.23 | < 0.001 | 0.94*** |
Change of albumin–creatinine ratio (mg/g)* | 16.34 | 270.9 | − 354.3 | 1923.5 | < 0.001 | 0.002*** |
Change of eGFR-MDRD (mL/min/1.73 m2) | − 4.10 | 14.77 | 5.37 | 18.53 | 0.001 | 0.002*** |
Chang of eGFR-CKD EPI (mL/min/1.73 m2) | − 3.35 | 12.59 | 3.80 | 15.72 | 0.004 | 0.012*** |
Change of pulse (/min) | 1.11 | 9.90 | − 16.95 | 22.97 | < 0.001 | < 0.001 |
Change of toe tuning fork score, right* | − 0.04 | 0.82 | 0.84 | 0.042 | 0.007 | 0.007 |
Change of toe tuning fork score, left* | 0.02 | 0.96 | 0.33 | 0.94 | 0.016 | 0.013 |
Change of ankle reflex score, right* | 0.00 | 0.11 | − 0.06 | 0.25 | 0.076 | 0.14 |
Change of ankle reflex score, left* | 0.00 | 0.13 | − 0.06 | 0.25 | 0.078 | 0.27 |
Change of monofilament score, right* | 0.00 | 0.07 | 0.01 | 0.08 | 0.30 | 0.47 |
Change of monofilament score, left* | 0.00 | 0.09 | 0.01 | 0.08 | 0.45 | 0.79 |
Change of visual acuity, right* | − 0.08 | 0.35 | − 0.06 | 0.36 | 0.73 | 0.88 |
Change of visual acuity, left* | − 0.06 | 0.36 | − 0.07 | 0.33 | 0.47 | 0.58 |
Change of non-proliferative retinopathy status, right (%) | 0.08 | 0.50 | 0.08 | 0.57 | 0.99 | 0.53 |
Change of non-proliferative retinopathy status, left (%) | 0.11 | 0.64 | 0.08 | 0.57 | 0.84 | 0.85 |
Change of proliferative retinopathy, left (%) | 0.01 | 0.19 | 0.00 | 0.00 | 0.71 | 0.54 |
Change of proliferative retinopathy (%) | 0.02 | 0.36 | 0.00 | 0.00 | 0.55 | 0.62 |
Metformin | 0.038 | 0.0 | 0.43 | |||
Sulfonylurea | 0.0059 | 0.0 | 0.91 | |||
Glitazone | 0.021 | − 0.041 | 0.017 | |||
DPP4-inhibitor | − 0.03 | 0.0 | 0.66 | |||
Thiazolidinedione | 0.047 | 0.02 | 0.52 | |||
GLP-1 analogues | 0.015 | 0 | 0.84 | |||
α-glucosidase inhibitor | − 0.006 | 0.02 | 0.051 | |||
Insulin | − 0.012 | − 0.041 | 0.41 | |||
ACE inhibitor /ARB | 0.02 | − 0.02 | 0.47 | |||
Other anti-hypertensives | 0.030 | − 0.12 | 0.0042 | |||
Statins | 0.11 | − 0.04 | 0.043 | |||
Anti-platelet therapy | 0.0088 | − 0.02 | 0.43 |
Medical therapy | Bariatric surgery | P value | |||
---|---|---|---|---|---|
Number | 338 | 49 | |||
Variable | Mean | SD | Mean | SD | |
Change of weight (kg) | − 2.37 | 2.64 | − 30.66 | 8.76 | < 0.001 |
Change of waist circumference (cm) | − 1.76 | 3.52 | − 26.43 | 7.08 | < 0.001 |
Change of body mass index (kg/m2) | − 0.89 | 0.93 | − 11.64 | 2.43 | < 0.001 |
Change of HbA1c (%)* | − 0.52 | 0.46 | − 2.91 | 0.81 | < 0.001 |
Change of fasting glucose (mg/dL)* | − 13.08 | 19.88 | − 75.06 | 34.12 | < 0.001 |
Change of LDL-C (mg/dL) | − 1.93 | 7.89 | − 5.91 | 27.76 | 0.59 |
Change of HLD-C (mg/dL) | 1.56 | 5.25 | 10.45 | 6.45 | < 0.001 |
Change of triglycerides (mg/dL)* | − 4.20 | 45.35 | − 184.41 | 156.38 | < 0.001 |
Change of systemic blood pressure (mmHg) | − 0.79 | 4.66 | − 18.82 | 17.07 | < 0.001 |
Change of diastolic blood pressure (mmHg) | − 3.43 | 3.39 | − 12.29 | 9.53 | 0.001 |
Change of creatinine (mg/dL)* | 0.24 | 1.26 | − 0.07 | 0.15 | < 0.001 |
Change of albumin–creatinine ratio (mg/g)* | 29.07 | 103.01 | − 454.9 | 1163.6 | < 0.001 |
Change of eGFR-MDRD (mL/min/1.73 m2) | − 5.45 | 5.36 | 3.59 | 11.09 | < 0.001 |
Change of eGFR-CKD-EPI (mL/min/1.73 m2) | − 3.94 | 3.97 | 3.45 | 9.67 | 0.007 |
Change of pulse (/min) | 1.67 | 3.45 | − 17.39 | 12.37 | < 0.001 |
Change of toe vibration fork score, right* | − 0.18 | 0.23 | 0.23 | 0.50 | 0.041 |
Change of toe vibration fork score, left* | − 0.14 | 0.25 | 0.22 | 0.61 | 0.069 |
Change of ankle reflex score, right* | − 0.01 | 0.06 | − 0.08 | 0.18 | 0.076 |
Change of ankle reflex score, left* | − 0.02 | 0.07 | − 0.08 | 0.18 | 0.078 |
Change of monofilament score, right* | 0.00 | 0.02 | 0.02 | 0.05 | 0.30 |
Change of monofilament score, left* | 0.00 | 0.03 | 0.02 | 0.05 | 0.45 |
Change of visual acuity, right* | − 0.05 | 0.11 | 0.01 | 0.22 | 0.73 |
Change of visual acuity, left* | − 0.02 | 0.11 | − 0.04 | 0.18 | 0.47 |
Change of non-proliferative retinopathy status, right (%) | 0.01 | 0.16 | 0.18 | 0.30 | 0.16 |
Change of non-proliferative retinopathy status, left (%) | 0.06 | 0.18 | 0.18 | 0.30 | 0.31 |
Change of proliferative retinopathy, right (%) | 0.04 | 0.08 | 0.00 | 0.00 | 0.050 |
Change of proliferative retinopathy, left (%) | 0.03 | 0.08 | 0.00 | 0.00 | 0.071 |
Medical therapy | Bariatric surgery | P value | |||
---|---|---|---|---|---|
Number | 125 | 43 | |||
Variable | Mean | SD | Mean | SD | |
Age (year) | 46.01 | 10.29 | 45.98 | 11.10 | 0.987 |
Gender (male %) | 44.00 | 46.51 | 0.859 | ||
BMI (kg/m2) | 32.86 | 4.31 | 34.60 | 5.02 | 0.030 |
Change of weight (kg) | − 1.57 | 7.32 | − 22.54 | 17.21 | < 0.001 |
Change of waist circumference (cm) | − 0.94 | 8.59 | − 20.51 | 11.51 | < 0.001 |
Change of body mass index (kg/m2) | − 0.64 | 2.52 | − 8.38 | 3.85 | < 0.001 |
Change of HbA1c (%)* | − 0.52 | 1.44 | − 2.76 | 1.47 | < 0.001 |
Change of fasting glucose (mg/dL)* | − 19.58 | 68.67 | − 76.13 | 68.84 | < 0.001 |
Change of LDL-C (mg/dL) | − 4.34 | 29.09 | − 13.90 | 49.78 | 0.244 |
Change of HLD-C (mg/dL) | 0.34 | 7.35 | 12.38 | 10.31 | < 0.001 |
Change of triglycerides (mg/dL)* | 2.98 | 154.26 | − 190.93 | 284.18 | < 0.001 |
Change of systolic blood pressure (mmHg) | 0.33 | 14.99 | − 17.81 | 28.59 | < 0.001 |
Change of diastolic blood pressure (mmHg) | − 4.09 | 11.40 | − 12.49 | 17.21 | 0.004 |
Change of creatinine (mg/dL)* | 0.04 | 0.14 | − 0.08 | 0.24 | 0.006 |
Change of albumin–creatinine ratio (mg/g)* | 53.89 | 395.42 | − 363.93 | 1996.91 | < 0.001 |
Change of eGFR-MDRD (mL/min/1.73 m2) | − 4.04 | 14.50 | 6.27 | 18.97 | 0.002 |
Change of eGFR-CKD-EPI (mL/min/1.73 m2) | − 2.97 | 10.56 | 4.32 | 16.37 | 0.009 |
Change of pulse (/min) | 1.40 | 10.20 | − 16.67 | 23.15 | < 0.001 |
Change of toe tuning fork score, right | − 0.21 | 0.67 | 0.37 | 0.81 | 0.001 |
Change of toe tuning fork score, left | − 0.15 | 0.71 | 0.43 | 0.92 | 0.002 |
Change of ankle reflex score, right* | 0.00 | 0.16 | − 0.08 | 0.24 | 0.081 |
Change of ankle reflex score, left* | − 0.01 | 0.18 | − 0.08 | 0.24 | 0.086 |
Change of monofilament score, right* | 0.00 | 0.08 | 0.01 | 0.08 | 0.39 |
Change of monofilament score, left* | 0.00 | 0.08 | 0.01 | 0.08 | 0.39 |
Change of visual acuity, right* | − 0.09 | 0.35 | − 0.06 | 0.37 | 0.69 |
Change of visual acuity, left* | − 0.05 | 0.35 | − 0.07 | 0.34 | 0.77 |
Change of non-proliferative retinopathy status, right (%) | − 0.04 | 0.50 | 0.04 | 0.56 | 0.50 |
Change of non-proliferative retinopathy status, left (%) | 0.06 | 0.52 | 0.04 | 0.56 | 0.87 |
Change of proliferative retinopathy, right (%) | 0.03 | 0.24 | 0.00 | 0.00 | 0.32 |
Change of proliferative retinopathy, left (%) | 0.03 | 0.24 | 0.00 | 0.00 | 0.32 |