Predictors of diabetes remission after bariatric surgery in Asia.
BACKGROUND
Obesity and type II diabetes mellitus (T2DM) are closely related and difficult to control by current medical treatment. Bariatric surgery has been proposed for inadequately controlled T2DM in association with obesity. However, prediction of successful T2DM remission after surgery has not been clearly studied in Asian patients. This information might be helpful for applying gastrointestinal surgery as metabolic surgery for T2DM.


METHODS
This was a retrospective clinical study. From January 2002 to December 2008, 88 consecutive patients with morbid obesity, who were enrolled into a surgically supervised weight loss program, and who had T2DM before surgery with at least 1 year complete follow-up data were included. Sixty-eight (77.2%) patients received gastric bypass procedures, and the remaining 20 (22.8%) received restrictive procedures. We analyzed the available information during the initial evaluation of patients who were referred for bariatric surgery, by logistic regression analysis and data mining methods for predictors of successful diabetes remission after surgery.


RESULTS
Overall, 68 (77.2%) of the 88 patients had remission of their T2DM 1 year after surgery. Patients in the bypass group had a higher remission rate than those in the restrictive group [59/68 (86.7%) vs. 9/20 (45.0%), p=0.000]. In univariate analysis, patients who had T2DM remission after surgery were younger, heavier, had a wider waist, less severe disease, shorter duration, and higher C-peptide levels than those without remission. Type of operation and T2DM duration remained independent predictors of success after multivariate logistical regression analysis (p<0.000). Data mining analysis confirmed that T2DM duration was the most important predictor.


CONCLUSIONS
Bariatric surgery is a treatment option for T2DM. Duration of diabetes is the most predictor of success after surgery.
Department of Surgery, Min-Sheng General Hospital, Taiwan. wjlee_obessurg_tw@yahoo.com.tw
Wei-Jei
WJ
Lee
Keong
K
Chong
Jung-Chien
JC
Chen
Kong-Han
KH
Ser
Yi-Chih
YC
Lee
Jun-Juin
JJ
Tsou
Shu-Chun
SC
Chen
D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome