Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes – a retrospective cohort study

Journal of Diabetes & Metabolic Disorders

KVS Hari Kumar²  Modukuri Swapna¹  Vishwas Naik¹  Vasisht Satwalekar¹  Sunil K Kota⁴  Kirtikumar D Modi³  Neeraj Gupta¹  Surendra Ugale¹ 

[1] Department of Advanced Laparoscopy and Metabolic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh, India;Department of Endocrinology, Command Hospital, Chandimandir 134107, Haryana, India;Department of Endocrinology, Medwin Hospital, Hyderabad, AP, India;Department of Endocrinology, Endocare Hospital, Vijayawada, AP, India

关键词: Metabolic surgery;    Diabetes remission;    Sleeve gastrectomy;    Ileal interposition;    Type 2 Diabetes;   

Others  :  1136141
DOI  :  10.1186/s40200-014-0089-y

 received in 2014-04-14, accepted in 2014-08-14,  发布年份 2014

【 摘 要 】

Background

Remission of diabetes is seen in more than 60% of patients after bariatric surgery. There is extensive variability in the remission rates between different surgical procedures. We analyzed our database and aimed to develop an easy scoring system to predict the probability of diabetes remission after two surgical procedures i.e. Ileal Interposition coupled with Sleeve Gastrectomy (IISG) or Diverted Sleeve Gastrectomy (IIDSG).

Methods

In this retrospective study, we analyzed records pertaining to patients who underwent IISG (n = 46) and IIDSG (n = 29). The primary outcome measure was diabetes remission (A1c <6.5% and not requiring hypoglycemic drugs). We identified seven preoperative clinical variables (age, duration of diabetes, body mass index, micro and macrovascular complications, use of insulin and stimulated C-peptide) based on our previous reports to be included in the diabetes remission score (DRS). The DRS score (7 – 14) was compared between the patients with and without remission in both the surgery groups.

Results

Mean DRS in patients who underwent IISG was 9.2 ± 1.4. Twenty one (46%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (8.1 ± 0.8 versus 10.2 ± 0.9, p < 0.0001). Mean DRS in patients who underwent IIDSG was 10.4 ± 1.3. Twenty one (72%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (9.7 ± 0.8 versus 12.0 ± 0.5, p < 0.0001). Patients with a DRS ≥ 10 in IISG group and more than 12 in IIDSG group did not get into remission.

Conclusion

Preoperative DRS can be a useful tool to select the type of surgical procedure and to predict the postoperative diabetes remission.

Trial registration

NCT00834626 webcite.

【 授权许可】

   
2014 Ugale et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Greenway SE, Greenway FL 3rd, Klein S: Effects of Obesity Surgery on Non Insulin Dependent Diabetes Mellitus. Arch Surg 2002, 137:1109-1117.
• [2]De Paula AL, Macedo AL, Rassi N, Machado CA, Schraibman V, Silva LQ, Halpern A: Laparoscopic Treatment of Type 2 Diabetes Mellitus for Patients with a Body Mass Index less than 35. Surg Endosc 2008, 22:706-716.
• [3]AL D p, Stival AR, Macedo A, Ribamar J, Mancini M, Halpern A, Vencio S: Prospective Randomized Controlled Trial Comparing 2 Versions of Laparoscopic Ileal Interposition Associated with Sleeve Gastrectomy for Patients with Type 2 Diabetes with BMI 21–34 kg/ m2. Surg Obes Relat Dis 2010, 6:296-305.
• [4]Tinoco A, El- Kadre L, Tinoco R, Savasi- Rocha P: Short-term and Mid-term Control of Type 2 Diabetes Mellitus by Laparoscopic Sleeve Gastrectomy with Ileal Interposition. World J Surg 2011, 35:2238-2244.
• [5]Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM: Who would have thought it? An Operation Proves to be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Ann Surg 1995, 222:339-350.
• [6]Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I: Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009, 122:248-256.
• [7]Dixon JB, Chuang LM, Chong K, Chen SC, Lambert GW, Straznicky NE, Lambert EA, Lee WJ: Predicting the glycemic response to gastric bypass surgery in patients with type 2 Diabetes. Diabetes Care 2013, 36:20-26.
• [8]Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D: Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003, 238:467-484.
• [9]Dixon JB, O’Brien PE: Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care 2002, 25:358-363.
• [10]Lee WJ, Hur KY, Lakadawala M, Kasama K, Wong SK, Lee YC: Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg 2012, 16:45-51.
• [11]Lee WJ, Chong K, Ser KH, Chen JC, Lee YC, Chen SC, Su YH, Tsai MH: C-peptide predicts the remission of type 2 diabetes after bariatric surgery. Obes Surg 2012, 22:293-298.
• [12]Still CD, Wood GC, Benotti P, Petrick AT, Gabrielsen J, Strodel WE, Ibele A, Seiler J, Irving BA, Celaya MP, Blackstone R, Gerhard GS, Argyropoulos G: Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol 2014, 2(1):38-45.
• [13]Hari Kumar KV, Ugale S, Gupta N, Naik V, Kumar P, Bhaskar P, Modi KD: Ileal Transposition with Sleeve Gastrectomy for Control of Type 2 Diabetes. Diabetes Technol Ther 2009, 11:1-5.
• [14]Kumar Kota S, Ugale S, Gupta N, Naik V, Krishna Kota S, Hari Kumar KVS, Modi KD: Remission of type 2 diabetes mellitus by ileal interposition with sleeve gastrectomy. Int J Endocrinol Metab 2011, 9:374-381.
• [15]Kota SK, Ugale S, Gupta N, Naik V, Kumar KV, Modi KD: Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus. Indian J Endocr Metab 2012, 16:589-598.
• [16]Kota SK, Ugale S, Gupta N, Modi KD: Laparoscopic ileal interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Diabetes Metab Syndr 2012, 6:125-131.
• [17]Kota SK, Ugale S, Gupta N, Krishna S, Modi KD: Ileal Interposition with diverted sleeve gastrectomy for treatment of type 2 diabetes. Indian J Endocr Metab 2012, 16:458-459.
• [18]Elariny H, González H, Wang B: Tissue thickness of human stomach measured on excised gastric specimens from obese patients. Surg Technol Int. 2005, 14:119-124.
• [19]Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, McLaughlin S, Phillips GL 2nd, Robertson RP, Rubino F, Kahn R, Kirkman MS: How do we define cure of diabetes? Diabetes Care 2009, 32(11):2133-2135.
• [20]Broglio F, Arvat E, Benso A, Gottero C, Muccioli G, Papotti M, van der Lely AJ, Deghenghi R, Ghigo E: Ghrelin, a Natural GH Secretagogue Produced by the Stomach, Induces Hyperglycemia and Reduces Insulin Secretion in Humans. J Clin Endocrinol Metab 2001, 86:5083-5086.
• [21]Lee WJ, Ser KH, Chong K, Lee YC, Chen SC, Tsou JJ, Chen JC, Chen CM: Laparoscopic sleeve gastrectomy for diabetes treatment in non morbidly obese patients: efficacy and change of insulin secretion. Surgery 2010, 147:664-669.
• [22]Scopinaro N, Adami GF, Papadia FS, Camerini G, Carlini F, Briatore L, D'Alessandro G, Parodi C, Weiss A, Andraghetti G, Catalano M, Cordera R: The effects of biliopancreatic diversion on type 2 diabetes mellitus in patients with mild obesity (BMI 30–35 kg/m2) and simple overweight (BMI 25–30 kg/m2): a prospective controlled study. Obes Surg 2011, 21:880-888.
• [23]Scopinaro N, Adami GF, Papadia FS, Camerini G, Carlini F, Fried M, Briatore L, D'Alessandro G, Andraghetti G, Cordera R: Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35. Ann Surg 2011, 253:699-703.
• [24]Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC: The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2009, 25:643-659.
• [25]Ramanan B, Gupta PK, Gupta H, Fang X, Forse RA: Development and validation of a bariatric surgery mortality risk calculator. J Am Coll Surg 2012, 214:892-900.
• [26]Rubino F, Marescaux J: Effect of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg 2004, 239:1-11.
• [27]Meier JJ, Gallwitz B, Siepmann N, Holst JJ, Deacon CF, Schmidt WE, Nauck MA: Gastric inhibitory polypeptide (GIP) dose-dependently stimulates glucagon secretion in healthy human subjects at euglycaemia. Diabetologia 2003, 46:798-801.
• [28]Kulkarni RN: GIP: no longer the neglected incretin twin? Sci Trans Med 2010, 2:49-47.
• [29]Hall TC, Pellen MG, Sedman PC, Jain PK: Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg 2010, 20:1245-1250.
• [30]Irwin N, Flatt PR: Evidence for beneficial effects of compromised gastric inhibitory polypeptide action in obesity-related diabetes and possible therapeutic implications. Diabetologia 2009, 52:1724-1731.
• [31]Saxena R, Hivert MF, Langenberg C, Tanaka T, Pankow JS, Vollenweider P, Lyssenko V, Bouatia-Naji N, Dupuis J, Jackson AU, Kao WH, Li M, Glazer NL, Manning AK, Luan J, Stringham HM, Prokopenko I, Johnson T, Grarup N, Boesgaard TW, Lecoeur C, Shrader P, O'Connell J, Ingelsson E, Couper DJ, Rice K, Song K, Andreasen CH, Dina C, Köttgen A, Le Bacquer O, et al.: Genetic variation in GIPR influences the glucose and insulin responses to an oral glucose challenge. Nat Genet 2010, 42:142-148.
• [32]Speliotes EK, Willer CJ, Berndt SI, Monda KL, Thorleifsson G, Jackson AU, Lango Allen H, Lindgren CM, Luan J, Mägi R, Randall JC, Vedantam S, Winkler TW, Qi L, Workalemahu T, Heid IM, Steinthorsdottir V, Stringham HM, Weedon MN, Wheeler E, Wood AR, Ferreira T, Weyant RJ, Segrè AV, Estrada K, Liang L, Nemesh J, Park JH, Gustafsson S, Kilpeläinen TO, et al.: Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index. Nat Genet 2010, 42:937-948.
• [33]Guyenet SJ, Schwartz MW: Clinical Review: Regulation of food intake, energy balance, and body fat mass: implications for the pathogenesis and treatment of obesity. J Clin Endocrinol Metab 2012, 97:745-755.
• [34]De Paula AL, Macedo AL, Prudente A, Silva L, Schraibman V, Neto JG: Neuroendocrine Brake for the Treatment of Morbid Obesity: Preliminary Report. Einstei 2005, 3:110-114.
• [35]Pereferrer FS, Gonzàlez MH, Rovira AF, Blasco SB, Rivas AM, del Castillo DD: Influence of sleeve gastrectomy on several experimental models of obesity: metabolic and hormonal implications. Obes Surg 2008, 18(1):97-108.
• [36]Nauck M, Stockmann F, Ebert R, Creutzfeldt W: Reduced Incretin Effect in Type 2 (noninsulin- dependent) Diabetes. Diabetologia 1986, 29:46-52.
• [37]Holst JJ: The Physiology of Glucagon-Like Peptide 1. Physiol Rev 2007, 87:1409-1439.
• [38]Kjems LL, Holst JJ, Volund A, Madsbad S: The Influence of GLP-1 on Glucose Stimulated Insulin Secretion: Effects on Beta-Cell Sensitivity in Type 2 and Nondiabetic Subjects. Diabetes 2003, 52:380-386.
• [39]Drucker DJ: Enhancing Incretin Action for the Treatment of Type 2 Diabetes. Diabetes care 2003, 26:2929-2940.
• [40]Irwin N, Gault VA, Green BD, Greer B, McCluskey JT, Harriott P, O'harte FP, Flatt PR: Effects of Short-Term Chemical Ablation of the GIP Receptor on Insulin Secretion, Islet Morphology and Glucose Homeostasis in Mice. Biol Chem 2004, 385:845-852.
• [41]Gault VA, Irwin N, Green BD, McCluskey JT, Greer B, Bailey CJ, Harriott P, O'harte FP, Flatt PR: Chemical Ablation of Gastric Inhibitory Polypeptide Receptor Action by Daily (Pro3) GIP Administration Improves Glucose Tolerance and Ameliorates Insulin Resistance and Abnormalities of Islet Structure in Obesity-Related Diabetes. Diabetes 2005, 54:2436-2446.
• [42]Ferrannini E, Cobelli C: The Kinetics of Insulin in Man. General Aspects. Diabetes Metab Rev 1987, 3:335-363.
• [43]Vilsboll T, Holst JJ: Incretins, Insulin Secretion and Type 2 Diabetes Mellitus. Diabetologia 2004, 47:357-366.
• [44]Aung K, Lorenzo C, Hinojosa MA, Haffner SM: Risk of developing diabetes and cardiovascular disease in metabolically unhealthy normal-weight and metabolically healthy obese individuals. J Clin Endocrinol Metab 2014, 99:462-468.