TY - JOUR
T1 - Outcomes in glycemic control in the intermediate follow-up of Roux-en-Y gastric bypass
T2 - a Brazilian cohort study
AU - Beleigoli, Alline Maria
AU - Coelho, Ana Luisa Bittencourt
AU - Diniz, Marco Túlio Costa
AU - Savassi-Rocha, Alexandre Lages
AU - Diniz, Maria de Fátima Haueisen Sander
PY - 2014/11/1
Y1 - 2014/11/1
N2 - BackgroundIt is not widely known whether glycemic control (GC) is sustained after Roux-en-Y gastric bypass (RYGB). The objective of this study was to investigate incidence and remission of type 2 diabetes mellitus (T2DM) among 284 individuals with body mass index (BMI)≥35 kg/m2 at operation (1998–2011) through 2013.MethodsBaseline GC was based on fasting glycemia (FG), hemoglobin A1c (HbA1c), and medication. Incident T2DM,
complete (normal GC/HbA1c) and partial (abnormal FG/A1c) remission at
the last follow-up visit, and relapse were the outcomes of interest. Kaplan-Meier curves
and log-rank tests were used to compare time to improvement according
to insulin use and HbA1c levels at baseline. Pre- and postoperative
determinants of T2DM improvement were investigated by logistic regression.ResultsParticipants were predominantly female (220; 77.2%) with mean age of 39.6 (10.5) years and median BMI of 51.9 (46.1–57.5) kg/m2 at operation. The mean follow-up time was 5.1 (3.2) years with 67.5% (55.0–78.4) of excess BMI loss (EBL) at the 5th
year. Normal GC, abnormal FG, and T2DM were observed in 169 (59.5%), 32
(11.2%), and 83 (29.3%) participants at baseline, respectively. The 7
(4.1%) patients with incident T2DM had lower BMI at baseline than those
who remained with normal GC (43.6 kg/m2 [42.0–50.8] versus 52.1 kg/m2 [46.7–57.7]; P
= .01). Complete and partial T2DM remission occurred in 61 (61.3%) and 5
(6.7%) participants, respectively. Baseline HbA1c was associated with a
significant difference in the proportion of cases with remission at the
5th year of follow-up (P = .016). Age (OR .83; 95% CI .72–.95) and % EBL at the 2nd
year of follow-up (OR 1.05; 95% CI 1.01–1.09) were independent
determinants of T2DM improvement. Relapse occurred in 14 (14.3%) cases.ConclusionWe observed a low incidence and impressive improvement rates of T2DM after intermediate follow-up of RYGB.
AB - BackgroundIt is not widely known whether glycemic control (GC) is sustained after Roux-en-Y gastric bypass (RYGB). The objective of this study was to investigate incidence and remission of type 2 diabetes mellitus (T2DM) among 284 individuals with body mass index (BMI)≥35 kg/m2 at operation (1998–2011) through 2013.MethodsBaseline GC was based on fasting glycemia (FG), hemoglobin A1c (HbA1c), and medication. Incident T2DM,
complete (normal GC/HbA1c) and partial (abnormal FG/A1c) remission at
the last follow-up visit, and relapse were the outcomes of interest. Kaplan-Meier curves
and log-rank tests were used to compare time to improvement according
to insulin use and HbA1c levels at baseline. Pre- and postoperative
determinants of T2DM improvement were investigated by logistic regression.ResultsParticipants were predominantly female (220; 77.2%) with mean age of 39.6 (10.5) years and median BMI of 51.9 (46.1–57.5) kg/m2 at operation. The mean follow-up time was 5.1 (3.2) years with 67.5% (55.0–78.4) of excess BMI loss (EBL) at the 5th
year. Normal GC, abnormal FG, and T2DM were observed in 169 (59.5%), 32
(11.2%), and 83 (29.3%) participants at baseline, respectively. The 7
(4.1%) patients with incident T2DM had lower BMI at baseline than those
who remained with normal GC (43.6 kg/m2 [42.0–50.8] versus 52.1 kg/m2 [46.7–57.7]; P
= .01). Complete and partial T2DM remission occurred in 61 (61.3%) and 5
(6.7%) participants, respectively. Baseline HbA1c was associated with a
significant difference in the proportion of cases with remission at the
5th year of follow-up (P = .016). Age (OR .83; 95% CI .72–.95) and % EBL at the 2nd
year of follow-up (OR 1.05; 95% CI 1.01–1.09) were independent
determinants of T2DM improvement. Relapse occurred in 14 (14.3%) cases.ConclusionWe observed a low incidence and impressive improvement rates of T2DM after intermediate follow-up of RYGB.
KW - Bariatric surgery
KW - Roux-en-Y gastric bypass
KW - Diabetes mellitus
KW - Incidence
KW - Remission
UR - http://www.scopus.com/inward/record.url?scp=84923858193&partnerID=8YFLogxK
U2 - 10.1016/j.soard.2014.08.016
DO - 10.1016/j.soard.2014.08.016
M3 - Article
SN - 1550-7289
VL - 10
SP - 1022
EP - 1027
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 6
ER -
