PMID- 28842774
OWN - NLM
STAT- MEDLINE
DCOM- 20190521
LR  - 20190521
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 32
IP  - 2
DP  - 2018 Feb
TI  - The impact of bariatric surgery on insulin-treated type 2 diabetes patients.
PG  - 990-1001
LID - 10.1007/s00464-017-5777-5 [doi]
AB  - INTRODUCTION: Bariatric surgery has been shown to lead to significant improvement 
      in glucose homeostasis, resulting in greater rates of type 2 diabetes mellitus 
      (T2DM) remission. While there is substantial evidence of the benefits of 
      bariatric/metabolic surgery in obese diabetic patients on oral therapy (O-T2D), 
      more evidence is necessary in the case of insulin-treated type 2 diabetes (I-T2D) 
      patients and the selection of surgical procedure. METHODS: Analysis of the 
      Ontario Bariatric Registry data was performed, comparing outcomes of 
      Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on insulin-treated 
      versus non-insulin-treated T2DM patients. We compared weight loss, medication use 
      and remission rates during a 3-year follow up. RESULTS: A total of 3668 diabetic 
      Bariatric Registry patients underwent surgery from Jan 2010 to Feb 2017, across 7 
      Bariatric Centers of Excellence in Ontario. Of these 2872 were O-T2D and 1187 
      were I-T2D. Weight loss was similar between the two groups at 3 years; with mean 
      %WL of 30.1% for the insulin group vs. 28.3% non-insulin (p = 0.0673). At 
      3 years, 11.3% of the non-insulin and 59.6% of the insulin-dependent group were 
      using anti-diabetic medication (p < 0.0001). Among insulin-dependent patients, 
      RYGB showed greater reduction in insulin use with 26.5 and 40% compared to SG at 
      3 years. O-T2D patients experienced more complete diabetes remission, with 66.5 
      vs. 18.5% (p < 0.0001) at 3 years. Complete remission for I-T2D patients was 
      higher in the RYGB group than SG (p < 0.0001) at years 1 and 2 (8.5 vs. 5.4% and 
      24.4 vs. 21.1%). The same trend was found regardless of insulin use; complete 
      remission higher for RYGB at 1 and 2 years [50.7 vs. 39.8% (p < 0.0001), and 54.6 
      vs. 49.1% (p < 0.0001)]. CONCLUSION: While both RYGB and SG procedures provide 
      effective treatment for I-T2D patients in terms of weight loss and diabetes, 
      incidence of complete remission for insulin-dependent patients is higher with 
      RYGB in earlier years.
FAU - Lemus, Rodrigo
AU  - Lemus R
AD  - McMaster University, G805, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, 
      Canada.
FAU - Karni, Dror
AU  - Karni D
AD  - McMaster University, G805, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, 
      Canada.
FAU - Hong, Dennis
AU  - Hong D
AD  - McMaster University, G805, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, 
      Canada.
FAU - Gmora, Scott
AU  - Gmora S
AD  - McMaster University, G805, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, 
      Canada.
FAU - Breau, Ruth
AU  - Breau R
AD  - McMaster University, G805, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, 
      Canada.
FAU - Anvari, Mehran
AU  - Anvari M
AD  - McMaster University, G805, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, 
      Canada. anvari@mcmaster.ca.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170825
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Diabetes Mellitus, Type 2/complications/*drug therapy/surgery
MH  - Follow-Up Studies
MH  - *Gastrectomy
MH  - *Gastric Bypass
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Insulin/*therapeutic use
MH  - Obesity/complications/*surgery
MH  - Ontario
MH  - Remission Induction
MH  - Treatment Outcome
MH  - Weight Loss
OTO - NOTNLM
OT  - Diabetes mellitus
OT  - Gastric bypass
OT  - Insulin dependence
OT  - Remission
OT  - Sleeve gastrectomy
EDAT- 2017/08/27 06:00
MHDA- 2019/05/22 06:00
CRDT- 2017/08/27 06:00
PHST- 2017/03/28 00:00 [received]
PHST- 2017/07/22 00:00 [accepted]
PHST- 2017/08/27 06:00 [pubmed]
PHST- 2019/05/22 06:00 [medline]
PHST- 2017/08/27 06:00 [entrez]
AID - 10.1007/s00464-017-5777-5 [pii]
AID - 10.1007/s00464-017-5777-5 [doi]
PST - ppublish
SO  - Surg Endosc. 2018 Feb;32(2):990-1001. doi: 10.1007/s00464-017-5777-5. Epub 2017 
      Aug 25.