A-103-or bariatric surgery and the mid-to-long term outcomes of diabetes in severely obese patients with type 2 diabetes at varying stages

Background: Evidences have proved that LRYGB is able to induce T2DM remission. Multiple studies have showed different predictors in the remission of T2DM after this procedure. Our objective is to determine the predictors of diabetes remission in T2DM patients that has undergone LRYGB in Asian. Methods: Data was collected on T2DM patients who underwent LRYGB from December 2005 to April 2012. Patients with T2DM who underwent LRYGB were included irrespective of the BMI and age. Data collected were gender, age, body height (BH) and body weight (BW), BMI, waist-hip ratio (WHR), FPG, HbA1c, c-peptide, duration of T2DM, oral hypoglycemic agent (OGHA) and/or insulin used and associated co morbidities. Patients were divided into three groups: total patients (group A), patients with BMI >35 (group B) and those with BMI < 35 (group C). Remission is defined as “FPG <100 mg/dL and HbA1c <6% without the use of OGHA or insulin therapy”. Glycemic control HbA1c of 7% despite no use of anti-diabetic medications. Data were collected prospectively and analyzed retrospectively. Results were analyzed to determine the remission of T2DM and its predictors. Results: Total patients included were 384 patients with BMI >35 were 260 and those with BMI < 35 were 124. In group A, mean age was 41.26yo, baseline mean BMI was 38.91kg/m2, FPG 165.63mg/dl, HbA1c 8.54%, cpeptide 3.58mg/dl. In group B, mean age was 38.97yo, baseline mean BMI 43.98kg/m2 FPG 155.64mg/dl, HbA1c 8.27%, c-peptide 4.13mg/dl. In group c, mean age was 46.06yo, baseline mean BMI was 29.33kg/m2 FPG 184.78mg/dl, HbA1c 9.02%, cpeptide 2.75mg/dl. The duration of the diabetes was range from newly diagnosed up to 20 years. Using univariate analysis the significant factors in predicting T2DM remission at 1 year were, age (p=0.000), BH (p=0.008), BW (p=0.000), WHR (p=0.035), BMI (p=0.000), FPG p=(0.030), HbA1C (p=0.000), cpeptide (p=0.000), duration of DM(p=0.000) and OGHA user (p=0.000), insulin user (p=0.030), and combination of OGHA and insulin user (p=0.000) in group A patients; in group B patients, significant factors were FPG (p=0.009) and fatty liver (p0.022), while in group C patients BW (p=0.000), BMI (p=0.000), OGHA usage (p=0.043) were significant. Using multivariate regression analysis, the significant predictors in group A were HbA1c (p=0.000) and cpeptide (p=0.031), in group B FPG (p=0.034) was the only significant predictors and C patients BW (p=0.000) was significant predictor. Conclusions: This study demonstrates the significant predictors of T2DM remission in total patients were HbA1c and cpeptide. In patients with BMI > 35 was FPG the only predictors, whereas in patient with BMI < 35 body weight is the significant predictor.