Remission and relapse of diabetes after sleeve gastrectomy and one‐anastomosis gastric bypass: The Tehran Obesity Treatment Study
Aims To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB). Methods An observational prospective study with 5 years of follow‐up was conducted in a total of...
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creator | Sadeghi, Sara Hosseinpanah, Farhad Khalaj, Alireza Ebadinejad, Amir Mahdavi, Maryam Valizadeh, Majid Barzin, Maryam |
description | Aims
To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB).
Methods
An observational prospective study with 5 years of follow‐up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level |
doi_str_mv | 10.1111/dom.15974 |
format | Article |
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To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB).
Methods
An observational prospective study with 5 years of follow‐up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose‐lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy.
Results
After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person‐months (95% confidence interval [CI] 56.8–66.4) and 5.7 per 1000 person‐months (95% CI 4.1–7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose‐lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB.
Conclusion
After 5 years of follow‐up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose‐lowering agents, despite possible remission, were at a higher risk of experiencing late relapse.</description><identifier>ISSN: 1462-8902</identifier><identifier>ISSN: 1463-1326</identifier><identifier>EISSN: 1463-1326</identifier><identifier>DOI: 10.1111/dom.15974</identifier><identifier>PMID: 39344845</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Anastomosis ; Blood Glucose - analysis ; Blood Glucose - metabolism ; Body mass index ; Diabetes ; diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - surgery ; Drug therapy ; Female ; Follow-Up Studies ; Gastrectomy ; Gastrectomy - methods ; Gastric bypass ; Gastric Bypass - methods ; Gastrointestinal surgery ; Glucose ; Glycated Hemoglobin - analysis ; Glycated Hemoglobin - metabolism ; Hemoglobin ; Humans ; Insulin ; Iran - epidemiology ; Male ; Middle Aged ; Obesity ; Obesity - complications ; Obesity - surgery ; Obesity, Morbid - complications ; Obesity, Morbid - surgery ; one‐anastomosis gastric bypass ; Patients ; Prospective Studies ; Recurrence ; relapse ; Remission ; Remission Induction ; sleeve gastrectomy ; Surgery ; Treatment Outcome</subject><ispartof>Diabetes, obesity & metabolism, 2024-12, Vol.26 (12), p.6007-6015</ispartof><rights>2024 John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2434-1a33d2cbff3d4b06aa8507a6e6553995544d187f09ca20de6ec1d34f705abdc33</cites><orcidid>0000-0001-7718-1952 ; 0000-0002-3405-6681 ; 0000-0002-3147-6103</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdom.15974$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdom.15974$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39344845$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sadeghi, Sara</creatorcontrib><creatorcontrib>Hosseinpanah, Farhad</creatorcontrib><creatorcontrib>Khalaj, Alireza</creatorcontrib><creatorcontrib>Ebadinejad, Amir</creatorcontrib><creatorcontrib>Mahdavi, Maryam</creatorcontrib><creatorcontrib>Valizadeh, Majid</creatorcontrib><creatorcontrib>Barzin, Maryam</creatorcontrib><title>Remission and relapse of diabetes after sleeve gastrectomy and one‐anastomosis gastric bypass: The Tehran Obesity Treatment Study</title><title>Diabetes, obesity & metabolism</title><addtitle>Diabetes Obes Metab</addtitle><description>Aims
To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB).
Methods
An observational prospective study with 5 years of follow‐up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose‐lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy.
Results
After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person‐months (95% confidence interval [CI] 56.8–66.4) and 5.7 per 1000 person‐months (95% CI 4.1–7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose‐lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB.
Conclusion
After 5 years of follow‐up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose‐lowering agents, despite possible remission, were at a higher risk of experiencing late relapse.</description><subject>Adult</subject><subject>Anastomosis</subject><subject>Blood Glucose - analysis</subject><subject>Blood Glucose - metabolism</subject><subject>Body mass index</subject><subject>Diabetes</subject><subject>diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Diabetes Mellitus, Type 2 - surgery</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrectomy</subject><subject>Gastrectomy - methods</subject><subject>Gastric bypass</subject><subject>Gastric Bypass - methods</subject><subject>Gastrointestinal surgery</subject><subject>Glucose</subject><subject>Glycated Hemoglobin - analysis</subject><subject>Glycated Hemoglobin - metabolism</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Insulin</subject><subject>Iran - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Obesity</subject><subject>Obesity - complications</subject><subject>Obesity - surgery</subject><subject>Obesity, Morbid - complications</subject><subject>Obesity, Morbid - surgery</subject><subject>one‐anastomosis gastric bypass</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>relapse</subject><subject>Remission</subject><subject>Remission Induction</subject><subject>sleeve gastrectomy</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>1462-8902</issn><issn>1463-1326</issn><issn>1463-1326</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10Utu1TAUBmALUdFSGLABZIkJDNL6lRcz1BZaqehKcBlHJ_YJTZXEFx8HlBkSG2CNrARz0zJAIh7Esj7_sv0z9kyKE5m-U-fHE5nXpXnAjqQpdCa1Kh7u5yqraqEO2WOiWyGE0VX5iB3qWhtTmfyI_fiAY0_U-4nD5HjAAXaE3Hfc9dBiROLQRQycBsSvyD8DxYA2-nHZb_AT_vr-E6a07EdPPa2it7xddkD0mm9vkG_xJsDENy1SHxe-DQhxxCnyj3F2yxN20MFA-PTuf8w-vb3Ynl1m15t3V2dvrjOrjDaZBK2dsm3XaWdaUQBUuSihwCLPdV3nuTFOVmUnagtKOCzQSqdNV4ocWme1PmYv19xd8F9mpNikq1scBpjQz9To9JZKqNKYRF_8Q2_9HKZ0uqSULgqRRlKvVmWDJwrYNbvQjxCWRormTzNNaqbZN5Ps87vEuR3R_ZX3VSRwuoJv_YDL_5Oa8837NfI3gG-aXA</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Sadeghi, Sara</creator><creator>Hosseinpanah, Farhad</creator><creator>Khalaj, Alireza</creator><creator>Ebadinejad, Amir</creator><creator>Mahdavi, Maryam</creator><creator>Valizadeh, Majid</creator><creator>Barzin, Maryam</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7718-1952</orcidid><orcidid>https://orcid.org/0000-0002-3405-6681</orcidid><orcidid>https://orcid.org/0000-0002-3147-6103</orcidid></search><sort><creationdate>202412</creationdate><title>Remission and relapse of diabetes after sleeve gastrectomy and one‐anastomosis gastric bypass: The Tehran Obesity Treatment Study</title><author>Sadeghi, Sara ; Hosseinpanah, Farhad ; Khalaj, Alireza ; Ebadinejad, Amir ; Mahdavi, Maryam ; Valizadeh, Majid ; Barzin, Maryam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2434-1a33d2cbff3d4b06aa8507a6e6553995544d187f09ca20de6ec1d34f705abdc33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Anastomosis</topic><topic>Blood Glucose - analysis</topic><topic>Blood Glucose - metabolism</topic><topic>Body mass index</topic><topic>Diabetes</topic><topic>diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Diabetes Mellitus, Type 2 - surgery</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrectomy</topic><topic>Gastrectomy - methods</topic><topic>Gastric bypass</topic><topic>Gastric Bypass - methods</topic><topic>Gastrointestinal surgery</topic><topic>Glucose</topic><topic>Glycated Hemoglobin - analysis</topic><topic>Glycated Hemoglobin - metabolism</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Insulin</topic><topic>Iran - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Obesity</topic><topic>Obesity - complications</topic><topic>Obesity - surgery</topic><topic>Obesity, Morbid - complications</topic><topic>Obesity, Morbid - surgery</topic><topic>one‐anastomosis gastric bypass</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>relapse</topic><topic>Remission</topic><topic>Remission Induction</topic><topic>sleeve gastrectomy</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sadeghi, Sara</creatorcontrib><creatorcontrib>Hosseinpanah, Farhad</creatorcontrib><creatorcontrib>Khalaj, Alireza</creatorcontrib><creatorcontrib>Ebadinejad, Amir</creatorcontrib><creatorcontrib>Mahdavi, Maryam</creatorcontrib><creatorcontrib>Valizadeh, Majid</creatorcontrib><creatorcontrib>Barzin, Maryam</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes, obesity & metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sadeghi, Sara</au><au>Hosseinpanah, Farhad</au><au>Khalaj, Alireza</au><au>Ebadinejad, Amir</au><au>Mahdavi, Maryam</au><au>Valizadeh, Majid</au><au>Barzin, Maryam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Remission and relapse of diabetes after sleeve gastrectomy and one‐anastomosis gastric bypass: The Tehran Obesity Treatment Study</atitle><jtitle>Diabetes, obesity & metabolism</jtitle><addtitle>Diabetes Obes Metab</addtitle><date>2024-12</date><risdate>2024</risdate><volume>26</volume><issue>12</issue><spage>6007</spage><epage>6015</epage><pages>6007-6015</pages><issn>1462-8902</issn><issn>1463-1326</issn><eissn>1463-1326</eissn><abstract>Aims
To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB).
Methods
An observational prospective study with 5 years of follow‐up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose‐lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy.
Results
After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person‐months (95% confidence interval [CI] 56.8–66.4) and 5.7 per 1000 person‐months (95% CI 4.1–7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose‐lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB.
Conclusion
After 5 years of follow‐up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose‐lowering agents, despite possible remission, were at a higher risk of experiencing late relapse.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>39344845</pmid><doi>10.1111/dom.15974</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7718-1952</orcidid><orcidid>https://orcid.org/0000-0002-3405-6681</orcidid><orcidid>https://orcid.org/0000-0002-3147-6103</orcidid></addata></record> |
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subjects | Adult Anastomosis Blood Glucose - analysis Blood Glucose - metabolism Body mass index Diabetes diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - surgery Drug therapy Female Follow-Up Studies Gastrectomy Gastrectomy - methods Gastric bypass Gastric Bypass - methods Gastrointestinal surgery Glucose Glycated Hemoglobin - analysis Glycated Hemoglobin - metabolism Hemoglobin Humans Insulin Iran - epidemiology Male Middle Aged Obesity Obesity - complications Obesity - surgery Obesity, Morbid - complications Obesity, Morbid - surgery one‐anastomosis gastric bypass Patients Prospective Studies Recurrence relapse Remission Remission Induction sleeve gastrectomy Surgery Treatment Outcome |
title | Remission and relapse of diabetes after sleeve gastrectomy and one‐anastomosis gastric bypass: The Tehran Obesity Treatment Study |
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