title: Diagnosis of diabetes remission after bariatic surgery may be jeopardized by remission criteria and previous hypoglycemic treatment.
abstract: BACKGROUND
  Controversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients' baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin therapy (IT).
  
  
  METHODS
  We performed a retrospective study from a cohort of 657 BS from a single center (2006-2011), of which 141 (57.4 % women) had T2D. We evaluated anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. T2D remission was defined according to 2009 consensus criteria: HbA1c <6%, fasting glucose (FG) <100 mg/dL, and absence of pharmacologic treatment. We analyzed diabetes remission according to previous treatment.
  
  
  RESULTS
  Preoperative characteristic were (mean ± SD): age 53.9 ± 9.8 years, BMI 43.7 ± 5.6 kg/m2, T2D duration 7.4 ± 7.6 years, FG 160.0 ± 54.6 mg/dL, HbA1c 7.6 ± 1.6%. Fifty-six (39.7%) individuals had IT. At 1-year follow-up, 74 patients (52.5%) had diabetes remission. Percentage weight loss (%WL) and percentage excess weight loss (%EWL) were associated to remission (35.5 ± 8.1 vs. 30.2 ± 9.5 %, p = 0.001; 73.6 ± 18.4 vs. 66.3 ± 22.8%, p = 0.037, respectively). Duration of diabetes, age, and female sex were associated to nonremission: 10.3 ± 9.4 vs. 4.7 ± 3.8 years, p < 0.001; 55.1 ± 9.3 vs. 51.2 ± 9.9 years, p = 0.017; 58.9 vs. 33.3%, p = 0.004, respectively. Prior treatment revealed differences in remission rates: 67.1 % in case of oral therapy (OT) vs. 30.4% in IT, p < 0.001. OR for T2D remission in patients with previous IT, compared to those with only OT, were 0.157-0.327 (p < 0.05), adjusting by different models.
  
  
  CONCLUSIONS
  Consensus criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Facultad de Medicina, Universidad Complutense, C/ Prof. Martin Lagos s/n., Madrid, 28040, Spain, ana_ramoslevi@hotmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Ramos-Levi
authors.forename: Andres
authors.initials: A
authors.lastname: Sanchez-Pernaute
authors.forename: Pilar
authors.initials: P
authors.lastname: Matia
authors.forename: Lucio
authors.initials: L
authors.lastname: Cabrerizo
authors.forename: Ana
authors.initials: A
authors.lastname: Barabash
authors.forename: Carmen
authors.initials: C
authors.lastname: Hernandez
authors.forename: Alfonso
authors.initials: A
authors.lastname: Calle-Pascual
authors.forename: Antonio
authors.initials: A
authors.lastname: Torres
authors.forename: Miguel
authors.initials: M
authors.lastname: Rubio
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015904:Biliopancreatic Diversion; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D057234:Preoperative Period; D012074:Remission Induction; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human