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Bariatric Surgery

Long-term diabetes outcomes after bariatric surgery—managing medication withdrawl

International Journal of Obesity volume 43, pages 2217–2224 (2019)Cite this article

Subjects

Abstract

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 (β = 1.06; p < 0.05) and a milder excess body weight loss (EBWL) (β = 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 (β = 0.54; p < 0.01) and higher first-year EBWL (β = 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.

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Authors and Affiliations

  1. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal

    Pedro Souteiro, Sandra Belo, Daniela Magalhães, Jorge Pedro, João Sérgio Neves, Sofia Castro Oliveira, Paula Freitas, Ana Varela & Davide Carvalho

  2. Faculty of Medicine of University of Porto, Porto, Portugal

    Pedro Souteiro, Daniela Magalhães, Jorge Pedro, João Sérgio Neves, Sofia Castro Oliveira, Paula Freitas, Ana Varela & Davide Carvalho

  3. Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal

    Pedro Souteiro, Daniela Magalhães, Jorge Pedro, João Sérgio Neves, Sofia Castro Oliveira, Paula Freitas, Ana Varela & Davide Carvalho

  4. Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal

    Sandra Belo, Paula Freitas & Ana Varela

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  1. Pedro Souteiro
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Correspondence to Pedro Souteiro.

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Souteiro, P., Belo, S., Magalhães, D. et al. Long-term diabetes outcomes after bariatric surgery—managing medication withdrawl. Int J Obes 43, 2217–2224 (2019). https://doi.org/10.1038/s41366-019-0320-5

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