Antidiabetic efficacy of obesity surgery in Germany

DianaCox

Bad Cop
Surg Obes Relat Dis. 2013 Jul 18. pii: S1550-7289(13)00234-7. doi: 10.1016/j.soard.2013.07.007. [Epub ahead of print]
Antidiabetic efficacy of obesity surgery in Germany: A quality assurance nationwide survey.
Weiner R1, El-Sayes I, Manger T, Weiner S, Lippert H, Stroh C; Obesity Surgery Working Group, Competence Network Obesity.
Author information

Abstract
BACKGROUND:
Obesity and diabetes usually co-exist. Obesity surgery seems to offer solutions for both. The objective of this study was to show the effect of obesity surgery on the diabetic profile.

METHODS:
Data on obesity surgery in Germany (2005-2011) were collected from the Institute of Quality Assurance at the research university. Follow-up of the diabetic profile at 1, 2, and up to 6 years after surgery was done.

RESULTS:
Among 17,670 patients, 5,506 (31.2%) were diabetics. Follow-up was accomplished in 87.4%, 82.5%, and 68.9% of eligible patients at 1, 2, and up to 6 years, respectively, after surgery. Of the study participants, 38.2% were insulin-treated (IT) patients and 61.8% were noninsulin-treated patients (NIT). Of the patients' procedures, 2878 (52.3%) Roux-en-Y gastric bypasses (RYGB), 1711 (31.1%) sleeve gastrectomies (SG), 679 (12.3%) laparoscopic adjustable gastric bands (LAGB), 165 (3%) biliopancreatic diversions with duodenal switch (BPD/DS), and 68 (1.3%) biliopancreatic diversions (BPD) were performed. Female gender percentage and mean body mass index (BMI) were significantly higher in the RYGB and LAGB groups. Mean age was significantly higher in BPD/DS group. At 1 year, remission/improvement (RI) percentage was 83.5%, 82.5%, 67.8%, 93.4%, and 84.8% after RYGB, SG, LAGB, BPD, and BPD/DS, respectively. At 2 years, RI% was 84.9%, 79.5%, 67.7%, 94.5%, and 90.9% after RYGB, SG, LAGB, BPD, and BPD/DS, respectively. At late follow-up, RI% was 83.2%, 59.5%, 58.9%, 100%, and 86.4% after RYGB, SG, LAGB, BPD, and BPD/DS, respectively. IT patients showed insignificantly higher RI% than NIT patients at all follow-up points. Malabsorptive procedures (RYGB, BPD, and BPD/DS) showed a significantly higher RI% than restrictive procedures (LAGB and SG) at late follow-up.

CONCLUSION:
Obesity surgery has promising antidiabetic efficacy, especially in IT patients. Malabsorptive procedures show higher, gradually descending, but durable antidiabetic efficacy.


Let's make that easier to read:

At 1 year, remission/improvement (RI) percentage was
83.5%, 82.5%, 67.8%, 93.4%, and 84.8% after
RYGB, SG, LAGB, BPD, and BPD/DS, respectively.

At 2 years, RI% was
84.9%, 79.5%, 67.7%, 94.5%, and 90.9% after
RYGB, SG, LAGB, BPD, and BPD/DS, respectively.

At late follow-up, RI% was
83.2%, 59.5%, 58.9%, 100%, and 86.4% after
RYGB, SG, LAGB, BPD, and BPD/DS, respectively.
 

MyNewLife

Roast Beef for dinner (shhhhh)
I'm showing off my stupid here. BPD is only part of the BPD/DS...why would the efficacy be better with only part of the surgery? Anyone have a clue?
 

Elizabeth N.

Herder of cats
In this article, BPD is probably referring to the now almost obsolete (but still done by a few European surgeons) Scopinaro procedure.
 

Munchkin

Full of Fairy Dust
It's not like we didn't already know this.... But it's good to have a real study with long term follow up.
 

BrianChesteen

Glad to be a Loser!
I am just guessing but I imagine the low number of samples for the BPD and the BPD/DS have skewed the numbers a bit...
 

DianaCox

Bad Cop
  • Follow-up was accomplished in 87.4%, 82.5%, and 68.9% of eligible patients at 1, 2, and up to 6 years, respectively, after surgery.
  • 165 (3%) biliopancreatic diversions with duodenal switch (BPD/DS), and 68 (1.3%) biliopancreatic diversions (BPD) were performed.
The follow-up number is generic to the whole set - but nearly 70% follow up at 6 years is remarkable.

I can't explain the better numbers for BPD, but @MyNewLife - BPD is essentially the same intestine as a DS, but a very large RNY-type horizontal gastrectomy, not half of a DS. The 100% at 6 years out seems suspect, because SOME percentage of T2Ds who have surgery have already lost all of their islet cells and CANNOT have a cure.
 
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