title: Determinants of Diabetes Remission and Glycemic Control After Bariatric Surgery.
abstract: OBJECTIVE
  Eligibility criteria for bariatric surgery in diabetes include BMI ≥35 kg/m(2) and poorly controlled glycemia. However, BMI does not predict diabetes remission, and thus, predictors need to be identified.
  
  
  METHODS
  Seven hundred twenty-seven patients were included in a database merged from the Swedish Obese Subjects (SOS) study and two randomized controlled studies, with 415 surgical and 312 medical patients in total. Bariatric operations were divided into gastric only (GO) and gastric plus diversion (GD).
  
  
  RESULTS
  Sixty-four percent of patients in the surgical arm and 15.0% in the medical arm experienced diabetes remission (P < 0.001). GO yielded 60% remission, and GD yielded 76% remission. The best predictors of diabetes remission were lower baseline glycemia and shorter diabetes duration. However, when operation type was considered, GD predicted a higher likelihood of remission and greater weight loss. Patients in remission (responders) lost more weight (25% vs. 17%) and waist circumference (18% vs. 13%) and experienced better insulin sensitivity than nonresponders.
  
  
  CONCLUSIONS
  Surgery is more effective than medical treatment in achieving diabetes remission and tighter glycemic control. Shorter diabetes duration, lower fasting glycemia before surgery, and GD versus GO procedures independently predict higher rates of remission, whereas baseline HbA1c and waist circumference predict improved glycemic control. The results show the advantage of an early operation together with better controlled glycemia on diabetes remission independently of BMI.
authors.affiliation: CNR-Institute for Systems Analysis and Computer Science (IASI), BioMatLab, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Panunzi
authors.affiliation: Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Carlsson
authors.affiliation: CNR-Institute for Systems Analysis and Computer Science (IASI), BioMatLab, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gaetano
authors.affiliation: Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.affiliation: Department of Internal Medicine, Catholic University, Rome, Italy.
authors.forename: Toni
authors.initials: T
authors.lastname: Rice
authors.affiliation: Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Sjöström
authors.affiliation: Department of Internal Medicine, Catholic University, Rome, Italy Department of Diabetes and Nutritional Sciences, King's College London, London, U.K. gmingrone@rm.unicatt.it.
authors.forename: Geltrude
authors.initials: G
authors.lastname: Mingrone
authors.affiliation: Obesity Research Unit, Department of General Practice, and Baker IDI Heart and Diabetes Institute, Monash University, Melbourne, Victoria, Australia.
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D013548:Sweden; D055105:Waist Circumference; D015431:Weight Loss
chemical_list: D001786:Blood Glucose