title: Predicting remission of diabetes after RYGB surgery following intensive management to optimize preoperative glucose control.
abstract: BACKGROUND
  The purpose of the study is to investigate the association of preoperative glucose optimization prior to a Roux-en-Y gastric bypass (RYGB) and diabetes remission.
  
  
  METHODS
  The study is a retrospective review of 245 patients with a history of diabetes type II and a RYGB from 2008 to 2012 at UMass Memorial Hospital.
  
  
  RESULTS
  Patients that benefited from glucose optimization prior to RYGB were more likely to achieve diabetes remission 1 year after surgery. The preoperative glucose optimization intervention demonstrated that when patients decreased their HbA1c prior to surgery by 1 %, these individuals were 68 % more likely to remit (p = 0.015). Duration of diabetes (p = 0.005) and insulin use (p < 0.001) were also significant predictors of remission, whereas age, race, and gender were not.
  
  
  CONCLUSIONS
  Our study results indicate that a greater degree of glycemic improvement in response to presurgical medical intervention is associated with higher rates of diabetes remission post-operatively among obese adults with diabetes type II. Conversely, the lack of favorable glycemic response to intensification of medical management predicts a poor glycemic response to bariatric surgery. Further research is needed to determine if this difference is due to physiological factors or is simply an indicator of patient behavior.
authors: Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01605, USA, Thomas.English@umassmed.edu.
authors: Thomas MacAndrew
authors: TM
authors: English
authors: Samir
authors: S
authors: Malkani
authors: Rebecca L
authors: RL
authors: Kinney
authors: Abdulkadir
authors: A
authors: Omer
authors: Mary Beth
authors: MB
authors: Dziewietin
authors: Richard
authors: R
authors: Perugini
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose