EFFECT OF METABOLIC SURGERY ON TYPE 2 DIABETES REMISSION: A MATCHED GROUP ANALYSIS
Keywords:
Bariatric metabolic surgery, Glycosylated hemoglobin, Obesity, Type 2 diabetes, Body Mass Index, Weight lossAbstract
Objectives: In this study it is proposed to analyse the effect of bariatric metabolic surgery on diabetes remission in obese type 2 diabetic patients compared to conventionally treated similar patients.
Methods: A retrospective review, of prospectively collected data base of conventionally treated group and metabolic group were screened from the year 2010-2013 at the study centre for patients satisfying the inclusion criteria. Three follow up data at an interval of three months and a base line value for both group were collected. Primary outcome measures the percentage of patient achieved diabetes remission, i.e. glycosylated haemoglobin (HbA1c)<6 % without active pharmacological therapy at one year and percentage of patients who achieved excess weight loss more than 60 % at one year.
Secondary outcome includes percentage reduction in medication use. Statistics used in the study is student‘t' test, Chi-square and ANOA (Analysis of Variance). The treatment effects were found to be significant to the least significant difference (LSD) at 5% level of significance.
Results: The patients underwent bariatric surgery had a significant improvement in glycemic status (HbA1c<6 %). In conventionally treated group less than 5% achieved HbA1c less than 6.5 % level with active pharmacological therapy. There was an increased use of antidiabetic medication with 2-5% increase in mean body weight in conventional group.
Conclusion: Compared to conventional therapy bariatric surgery markedly improves diabetes and results in discontinuation or marked reduction of anti-diabetic medications in majority of patients treated. So bariatric surgery seems to be a better option for the obese diabetic patients.
Â
Downloads
References
Nocca D, Krawczykowsky D. A prospective multicenter study of 163 sleevegastrectomies. Obesity Surgery 2008;18:560-5.
Pi-Sunyer X, Blackburn. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes. Diabetes Care 2007;30:1374-83.
Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R. Medical management of hyperglycemia in type 2diabetes. Diabetes Care 2009;32:193-203.
Garber A, Henry R, Ratner R, Garcia-Hernandez PA, Rodriguez-Pattzi H, Olvera Alvarez I, et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes. Lancet 2009;373:473-81.
Raz I, Hanefeld M, Xu L, Caria C, Williams Herman D, Khatami H, et al. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy in patients with type 2 diabetes mellitus. Diabetologia 2006;49;2564 71.
DE Mumme, Michal Mathiason, Kara J Kallies, B Shanu N Kothari. Effect of bypass surgery on HbA1c. Surgery Obesity Related Disease 2009;5:4-10.
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery Systematic review and metaanalysis. Am J Med 2009;122:248-56.
D’Hondt M, Vanneste S. Laproscopic sleeve gastrectomy as aprocedure for morbid obesity and resolution of comorbidities. Surg Endose 2011;25:2498-504.
Dixon JB, Zimmet P, Alberti KG, Rubino F. Bariatric surgery: an IDF statement for obese Type 2 diabetes. Diabetic Med 2011;28:628–42.
Kalra S, Unnikrishnan AG. Obesity in India: The weight of the nation. J Med Nutr Nutraceuticals 2012;1:37-41.
Inghai A, Sharma P, Jha RK. Effect of sleeve gastrectomy and gastric bypass on diabetic Control in India. Saudi J Obesity 2014;2:59-62.