title: Outcomes of bariatric surgery in type 2 diabetic patients with diminished pancreatic secretory reserve.
abstract: Although the marked and durable effects of bariatric surgery on early type 2 diabetes is known, there are limited data on the impact of surgery in patients with reduced beta-cell function/reserve. Clinical outcomes of 15 morbidly obese patients with poorly controlled diabetes who underwent bariatric surgery in a 10-year period and had a baseline fasting serum c-peptide ≤0.5 ng/mL were assessed. All patients had glycated hemoglobin >7 % and were on insulin before surgery. Surgical procedures included laparoscopic gastric bypass (n = 9), sleeve (n = 5), and banding (n = 1) without any intraoperative complications. At a mean follow-up of 39.6 ± 22.9 months, a mean reduction in body mass index of 25.1 ± 9.2 % and a mean percent excess weight loss of 61.5 ± 19.7 % were associated with a significant improvement in daily insulin requirement and lipid profile. At the last follow-up point, three patients (20 %) were off insulin, five patients (33.3 %) had a glycated hemoglobin ≤7 %, and one patient (6.7 %) had remission of diabetes. Hypertension resolved or improved in 5 of 11 (45.5 %) hypertensive patients. In conclusion, bariatric surgery can result in improvement of glycemic status and comorbid conditions of obese diabetic patients with diminished beta-cell reserve and may facilitate medical management of diabetes.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA, aminiaa@ccf.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Daigle
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.forename: Bartolome
authors.initials: B
authors.lastname: Burguera
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Kashyap
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D050417:Insulin-Secreting Cells / Q000378:metabolism* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D010179:Pancreas / Q000378:metabolism / Q000473:pathology; D010182:Pancreatic Diseases / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D011184:Postoperative Period; D012074:Remission Induction; D016896:Treatment Outcome