Association of weight loss with diabetes remission after metabolic surgery in patients with type 2 diabetes for 10 years and above / 中华临床营养杂志

ABSTRACT

Objective:To explore the association of weight loss with diabetes remission after metabolic surgery in patients with type 2 diabetes mellitus(T2DM) for 10 years and more.Methods:Data of T2DM patients with obesity who underwent metabolic surgery in the General Surgery Department & Obesity and Metabolic Disease Center of China-Japan Friendship Hospital from November 2017 to June 2021 were retrospectively collected and analyzed. Remission of diabetes was defined as glycated hemoglobin (HbA1c) < 6.5% or fasting blood glucose < 7.0 mmol/L after discontinuing anti-diabetic medication for more than 3 months. The patients were followed up and divided into two groups according to whether the percentage total weight loss (%TWL) was ≥ 20% or not. The age, sex, body mass index (BMI), fasting C-peptide, and HBA1c were compared between the two groups.Results:Among 65 (28 males and 37 females) patients with T2DM for ≥ 10 years , 50 (76.9%) achieved diabetes remission after a median of 12-month follow-up. 6.2%, 41.5% , 38.5% and 13.8% of the patients achieved %TWL < 10%, 10~20%, 20~30% and ≥ 30% , respectively. The diabetes remission rates were 50%, 63.0%, 92.0% and 88.9%, respectively. Compared with the %TWL < 20% group, the preoperative weight [(95.5±18.8) kg vs (85.5±11.0) kg, P = 0.012] and BMI [(34.4±6.0) vs (30.9±3.3) , P = 0.006] were significantly higher in the %TWL ≥ 20% group, and diabetes remission rates was aslo significantly higher in the %TWL ≥ 20% group (91.2% vs 61.3%, P = 0.010) . After adjusting for age, preoperative BMI, fasting C-peptide and duration of T2DM, Cox multivariate regression analysis showed that %TWL ≥ 20% was independently associated with diabetic remission after metabolic surgery in patients with T2DM for ≥ 10 years (HR = 1.99, 95% CI 1.03 to 3.83, P = 0.04). Conclusions:More than 70% of patients with T2DM for ≥ 10 years could achieve diabetes remission after metabolic surgery. %TWL ≥ 20% may be one independent factor of diabetes remission in patients with long-duration T2DM.