PMID- 34518376 OWN - NLM STAT- MEDLINE DCOM- 20220308 LR - 20230102 IS - 1935-5548 (Electronic) IS - 0149-5992 (Print) IS - 0149-5992 (Linking) VI - 45 IP - 1 DP - 2022 Jan 1 TI - Minimum Threshold of Bariatric Surgical Weight Loss for Initial Diabetes Remission. PG - 92-99 LID - 10.2337/dc21-0714 [doi] AB - OBJECTIVE: There are few studies testing the amount of weight loss necessary to achieve initial remission of type 2 diabetes mellitus (T2DM) following bariatric surgery and no published studies with use of weight loss to predict initial T2DM remission in sleeve gastrectomy (SG) patients. RESEARCH DESIGN AND METHODS: With Cox proportional hazards models we examined the relationship between initial T2DM remission and percent total weight loss (%TWL) after bariatric surgery. Categories of %TWL were included in the model as time-varying covariates. RESULTS: Of patients (N = 5,928), 73% were female; mean age was 49.8 +/- 10.3 years and BMI 43.8 +/- 6.92 kg/m2, and 57% had Roux-en-Y gastric bypass (RYGB). Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of T2DM (mean time to remission 1.0 year). With 0-5% TWL used as the reference group in Cox proportional hazards models, patients were more likely to remit with each 5% increase in TWL until 20% TWL (hazard ratio range 1.97-2.92). When categories >25% TWL were examined, all patients had a likelihood of initial remission similar to that of 20-25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0-5% TWL, even if they were using insulin at the time of surgery. CONCLUSIONS: Weight loss after bariatric surgery is strongly associated with initial T2DM remission; however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. Achieving this threshold is also associated with initial remission even in patients who traditionally experience lower rates of remission, such as patients taking insulin. CI - (c) 2021 by the American Diabetes Association. FAU - Barthold, Douglas AU - Barthold D AD - 1Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA. FAU - Brouwer, Elizabeth AU - Brouwer E AD - 1Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA. FAU - Barton, Lee J AU - Barton LJ AD - 2Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. FAU - Arterburn, David E AU - Arterburn DE AD - 3Kaiser Permanente Washington Health Research Institute, Seattle, WA. FAU - Basu, Anirban AU - Basu A AUID- ORCID: 0000-0003-4238-7402 AD - 1Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA. AD - 4Departments of Health Services and Economics, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA. FAU - Courcoulas, Anita AU - Courcoulas A AUID- ORCID: 0000-0002-4973-7869 AD - 5Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. FAU - Crawford, Cecelia L AU - Crawford CL AD - 6Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA. FAU - Fedorka, Peter N AU - Fedorka PN AD - 7Department of Surgery, Kaiser Permanente San Bernardino Medical Center, Kaiser Permanente Southern California, Ontario, CA. FAU - Fischer, Heidi AU - Fischer H AD - 3Kaiser Permanente Washington Health Research Institute, Seattle, WA. FAU - Kim, Benjamin B AU - Kim BB AD - 8Department of Surgery, Kaiser Permanente South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, CA. FAU - Mun, Edward C AU - Mun EC AD - 8Department of Surgery, Kaiser Permanente South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, CA. FAU - Murali, Sameer B AU - Murali SB AD - 9Center for Healthy Living, Kaiser Permanente San Bernardino Medical Center, Kaiser Permanente Southern California, Fontana, CA. FAU - Reynolds, Kristi AU - Reynolds K AUID- ORCID: 0000-0001-7619-1649 AD - 2Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. FAU - Yoon, Tae K AU - Yoon TK AD - 2Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. FAU - Zane, Robert E AU - Zane RE AD - 8Department of Surgery, Kaiser Permanente South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, CA. FAU - Coleman, Karen J AU - Coleman KJ AUID- ORCID: 0000-0002-2052-0885 AD - 2Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. LA - eng SI - figshare/10.2337/figshare.15113349 GR - R01 HL130462/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Diabetes Care JT - Diabetes care JID - 7805975 SB - IM CIN - Diabetes Care. 2022 Jan 1;45(1):28-30. PMID: 34986262 MH - Adult MH - *Bariatric Surgery MH - *Diabetes Mellitus, Type 2/complications/surgery MH - Female MH - Gastrectomy MH - *Gastric Bypass MH - Humans MH - Middle Aged MH - *Obesity, Morbid/complications/surgery MH - Retrospective Studies MH - Treatment Outcome MH - Weight Loss PMC - PMC8753771 EDAT- 2021/09/15 06:00 MHDA- 2022/03/09 06:00 PMCR- 2023/01/01 CRDT- 2021/09/14 05:56 PHST- 2021/03/31 00:00 [received] PHST- 2021/08/02 00:00 [accepted] PHST- 2021/09/15 06:00 [pubmed] PHST- 2022/03/09 06:00 [medline] PHST- 2021/09/14 05:56 [entrez] PHST- 2023/01/01 00:00 [pmc-release] AID - dc21-0714 [pii] AID - 210714.45.1 [pii] AID - 10.2337/dc21-0714 [doi] PST - ppublish SO - Diabetes Care. 2022 Jan 1;45(1):92-99. doi: 10.2337/dc21-0714.