Predictors of long-term diabetes remission after metabolic surgery

Bariatric/metabolic surgery has been proposed for the treatment of inadequately controlled type 2 diabetes mellitus (T2DM) in obese patients. However, prediction on successful long-term remission of T2DM after metabolic surgery has not been clearly studied. Our objectives were to evaluate rates of long-term remission of T2DM after metabolic surgery and determine the independent predictors of remission.

Outcomes of 157 patients who underwent metabolic surgery between 2006 and 2009 and who had complete 5-year follow-up data were assessed. Prolonged complete remission was defined as glycated hemoglobin (HbA1c) less than 6 % without diabetes medication up to 5 years. Predictors of prolonged remission studies included patient characteristics such as glucose level, HbA1c, body weight, waist circumference, blood pressure, total cholesterol, LDL, triglyceride, uric acid, AST, alanine transaminase (ALT), albumin, insulin, C-peptide, iron, calcium, complete blood cell count, the ABCD score (a multidimensional grading system composed of age, body mass index (BMI), C-peptide levels, and duration of T2DM), and postoperative weight loss.

At 5 years after surgery, the weight loss was 27.1 % and the mean BMI decreased from 39.8 to 28.8 kg/m(2). The mean HbA1c decreased from 8.3 to 6.0 %. A significant number of patients had improvement in their glycemic control, including 97 (71.3 %) patients who had complete remission (HbA1c < 6.0 %), 27 (19.9 %) partial remission (HbA1c < 6.5 %), and 12 (8.8 %) improved condition (HbA1c < 7 %). In univariate analysis, patients with prolonged T2DM remission after surgery were younger and heavier; had a wider waist, higher C-peptide, shorter duration of T2DM, higher liver enzyme, higher insulin resistance, higher C-peptide level, and higher white blood cell count; were taking smaller insulin dosage; had higher ABCD score; and had greater weight loss than those without remission. Multivariate logistical regression analyses showed that the ABCD score and weight loss were the only predictors of remission after metabolic surgery.

Metabolic surgery is a treatment option for patients with obesity and T2DM. Baseline ABCD score and weight loss have a major influence on outcome.