title: Diabetes remission and glycemic response to pre-bariatric surgery diet.
abstract: BACKGROUND
  Before bariatric surgery, some patients with type 2 diabetes mellitus (T2DM) experience improvement in blood glucose control and reduced insulin requirements while on a preoperative low-calorie diet (LCD). We hypothesized that patients who exhibit a significant glycemic response to this diet are more likely to experience remission of their diabetes in the postoperative period.
  
  
  METHODS
  Insulin-dependent T2DM patients undergoing bariatric surgery between August 2006 and February 2011 were eligible for inclusion. Insulin requirements at day 0 and 10 of the LCD were compared. Patients with a ≥ 50% reduction in total insulin dosage to maintain appropriate blood glucose control were considered rapid responders to the preoperative LCD. All others were non-rapid responders. We analyzed T2DM remission rates up to 1 y postoperatively.
  
  
  RESULTS
  A total of 51 patients met inclusion criteria and 29 were categorized as rapid responders (57%). The remaining 22 were considered non-rapid responders (43%). The two groups did not differ demographically. Rapid responders had greater T2DM remission rates at 6 (44% versus 13.6%; P = 0.02) and 12 mo (72.7% versus 5.9%; P < 0.01). In patients undergoing laparoscopic gastric bypass, rapid responders showed greater excess weight loss at 3 mo (40.1% versus 28.2%; P < 0.01), 6 mo (55.2% versus 40.2%; P < 0.01), and 12 mo (67.7% versus 47.3%; P < 0.01).
  
  
  CONCLUSIONS
  Insulin-dependent T2DM bariatric surgery patients who display a rapid glycemic response to the preoperative LCD are more likely to experience early remission of T2DM postoperatively and greater weight loss.
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Biro
authors.forename: Diane L
authors.initials: DL
authors.lastname: Olson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Garren
authors.forename: Jon C
authors.initials: JC
authors.lastname: Gould
mesh_terms: D050110:Bariatric Surgery; D001786:Blood Glucose; D031204:Caloric Restriction; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000378:metabolism* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy / Q000378:metabolism / Q000601:surgery*; D057234:Preoperative Period; D012074:Remission Induction; D012189:Retrospective Studies; D015431:Weight Loss
chemical_list: D001786:Blood Glucose
keywords: Bariatric surgery; Diabetes remission; Preoperative liquid diet; Type 2 diabetes