PMID- 30696933 OWN - NLM STAT- MEDLINE DCOM- 20200601 LR - 20221207 IS - 1476-5497 (Electronic) IS - 0307-0565 (Linking) VI - 43 IP - 11 DP - 2019 Nov TI - Long-term diabetes outcomes after bariatric surgery-managing medication withdrawl. PG - 2217-2224 LID - 10.1038/s41366-019-0320-5 [doi] AB - BACKGROUND/OBJECTIVES: Bariatric surgery leads to type 2 diabetes mellitus (T2DM) remission, but recurrence can ensue afterwards. However, literature provides heterogenous remission/recurrence criteria and there is no consensus on long-term T2DM management after surgery. We aim to assess T2DM remission/recurrence rates using standardized criteria and to identify relapse predictors. We also intend to analyze the management of residual T2DM and the impact of maintaining/withdrawing metformin in avoiding future relapse. SUBJECTS/METHODS: We investigated a cohort of 110 obese patients with T2DM who underwent bariatric surgery and were followed for 5 years (Y0-Y5). Patients who ever attained remission were accounted for cumulate remission, while prevalent remission was considered for individuals who were on remission in a specific visit. RESULTS: A complete prevalent remission of 47.3% was reached at Y1 and it remained stable till Y5 (46.4-48.2%). Complete cumulative rate was of 57.3% at Y5. Five-year T2DM recurrence rate was 15.9% and it was associated with higher pre-operative HbA1c levels (beta = 1.06; p < 0.05) and a milder excess body weight loss (EBWL) (beta = 0.49; p < 0.05). Glucose-lowering agents were fully stopped in 51.4% of the patients till Y1 and in 16.2% of them afterwards. Medication withdrawal was mainly attempted in patients with a lower baseline HbA1c (beta = 0.54; p < 0.01) and higher first-year EBWL (beta = 1.04; p < 0.01). Patients that kept metformin after reaching a HbA1c in the complete remission range (<6.0%) did not have greater odds of avoiding relapse in the next visit (OR = 0.33; p = 0.08). CONCLUSIONS: Baseline HbA1c and EBWL were the main variables driving both T2DM relapse after bariatric surgery and the attempt to withdrawal anti-diabetic medication. In our population keeping metformin once an HbA1c < 6.0% is achieved did not seem to diminish relapse but further studies on this matter are needed. FAU - Souteiro, Pedro AU - Souteiro P AUID- ORCID: 0000-0002-1359-814X AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. pedrobsouteiro@gmail.com. AD - Faculty of Medicine of University of Porto, Porto, Portugal. pedrobsouteiro@gmail.com. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. pedrobsouteiro@gmail.com. FAU - Belo, Sandra AU - Belo S AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar Sao Joao, Porto, Portugal. FAU - Magalhaes, Daniela AU - Magalhaes D AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Faculty of Medicine of University of Porto, Porto, Portugal. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. FAU - Pedro, Jorge AU - Pedro J AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Faculty of Medicine of University of Porto, Porto, Portugal. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. FAU - Neves, Joao Sergio AU - Neves JS AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Faculty of Medicine of University of Porto, Porto, Portugal. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. FAU - Oliveira, Sofia Castro AU - Oliveira SC AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Faculty of Medicine of University of Porto, Porto, Portugal. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. FAU - Freitas, Paula AU - Freitas P AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Faculty of Medicine of University of Porto, Porto, Portugal. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. AD - Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar Sao Joao, Porto, Portugal. FAU - Varela, Ana AU - Varela A AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Faculty of Medicine of University of Porto, Porto, Portugal. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. AD - Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar Sao Joao, Porto, Portugal. FAU - Carvalho, Davide AU - Carvalho D AD - Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Sao Joao, Porto, Portugal. AD - Faculty of Medicine of University of Porto, Porto, Portugal. AD - Instituto de Investigacao e Inovacao em Saude, University of Porto, Porto, Portugal. CN - Multidisciplinary Group for Surgical Management of Obesity LA - eng PT - Journal Article DEP - 20190129 PL - England TA - Int J Obes (Lond) JT - International journal of obesity (2005) JID - 101256108 RN - 0 (Glycated Hemoglobin A) RN - 0 (Hypoglycemic Agents) RN - 0 (hemoglobin A1c protein, human) RN - 9100L32L2N (Metformin) SB - IM MH - Adult MH - *Bariatric Surgery MH - Body Weight/physiology MH - *Diabetes Mellitus, Type 2/complications/drug therapy MH - Female MH - Glycated Hemoglobin/analysis MH - Humans MH - Hypoglycemic Agents/administration & dosage/therapeutic use MH - Male MH - Metformin/administration & dosage/therapeutic use MH - Middle Aged MH - *Obesity/complications/surgery MH - Remission Induction MH - Retrospective Studies MH - Treatment Outcome MH - Weight Loss/physiology EDAT- 2019/01/31 06:00 MHDA- 2020/06/02 06:00 CRDT- 2019/01/31 06:00 PHST- 2018/06/25 00:00 [received] PHST- 2019/01/04 00:00 [accepted] PHST- 2018/12/20 00:00 [revised] PHST- 2019/01/31 06:00 [pubmed] PHST- 2020/06/02 06:00 [medline] PHST- 2019/01/31 06:00 [entrez] AID - 10.1038/s41366-019-0320-5 [pii] AID - 10.1038/s41366-019-0320-5 [doi] PST - ppublish SO - Int J Obes (Lond). 2019 Nov;43(11):2217-2224. doi: 10.1038/s41366-019-0320-5. Epub 2019 Jan 29.