OBES SURG online Nov 17
David E. Arterburn & Andy Bogart & Nancy E. Sherwood & Stephen Sidney & Karen J. Coleman & Sebastien Haneuse & Patrick J. O’Connor & Mary Kay Theis & Guilherme M. Campos & David McCulloch & Joe Selby
CLINICAL RESEARCH
Abstract
Background Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predic- tors of diabetes remission and relapse among patients under- going gastric bypass.
Methods We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2
The work described here was presented at the March 2011 annual meeting of the Health Maintenance Organization Research Network in Boston, MA
D. E. Arterburn (*) : A. Bogart : M. K. Theis : D. McCulloch Group Health Research
Patients with diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the USA. Remission and relapse events were defined by diabetes med- ication use and clinical laboratory measures of glycemic con- trol.
We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass. Results Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years.
The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p 0 0.03).
Conclusions Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.
Nyhetsinfo
Välgjord uppföljningsstudie på drygt 4400 GB kir pat i Californinen och Minnesota där 68% hade en komplett remission (def ej diab läkem, fastesocker <5,6, HbA1c < 6% DCCT ≥90 dgr efter senaste diab receptförskr) inom 5 år efter kir. Av dessa fick 35% åter diabetes. Medianremissionstiden var 8,3 år.
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