Gastric bypass in Type 2 diabetes with BMI < 30: Weight and weight loss have a major influence on outcomes

J. B. Dixon, K. Y. Hur, W. J. Lee, M. J. Kim, K. Chong, S. C. Chen, N. E. Straznicky, P. Zimmet

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50 Citations (Scopus)

Abstract

Aim To assess factors influencing glycaemic control following gastric bypass surgery in patients with Type 2 diabetes and BMI< 30 kg/m2. Methods Prospective longitudinal study of 103 patients with inadequate glycaemic control who underwent gastric bypass surgery at Soonchunhyang University, Seoul, Korea (n = 66) and Min-Sheng General Hospital, Taipei, Taiwan (n = 37). Procedures were performed August 2009 to January 2011. Key outcome measures were excellent glycaemic control of Type 2 diabetes defined as HbA1c < 42 mmol/mol (≥ 6%); inadequate response defined as HbA1c > 53 mmol/ mol (> 7%). Analysis was conducted using binary logistic regression, and cut-points obtained from receiver operator characteristics. Results Excellent glycaemic control was achieved in 31 (30%) at 1 year. Diabetes duration of < 7 years and BMI > 27 kg/m2 provided independent predictors and useful cut-points. Likelihood of excellent glycaemic control for an individual could be estimated using loge (Odds) = –6.7 + (0.26 × BMI) + (–1.2 9 diabetes duration). Baseline BMI of < 27 kg/m2 and baseline C-peptide of < 2.0ng/ml, best predicted a poor glycaemic response. In those with favourable baseline characteristics percentage weight loss (%WL) had a dominant influence on glycaemic outcomes. Baseline C-peptide (> 2.4 ng/ml) and subsequent percentage weight loss (> 16%) were associated with excellent glycaemic control. Higher BMI was associated with greater percentage weight loss. Conclusion In patients with Type 2 diabetes and BMI < 30 kg/m2, glycaemic response to gastric bypass is predicted by higher baseline BMI, shorter disease duration and higher fasting C-peptide. Post-surgery weight loss has a dominant effect. Baseline BMI and weight loss have a major influence on outcomes.

LanguageEnglish
Pagese127-e134
JournalDiabetic Medicine
Volume30
Issue number4
DOIs
Publication statusPublished - 1 Apr 2013
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Dixon, J. B., Hur, K. Y., Lee, W. J., Kim, M. J., Chong, K., Chen, S. C., ... Zimmet, P. (2013). Gastric bypass in Type 2 diabetes with BMI < 30: Weight and weight loss have a major influence on outcomes. Diabetic Medicine, 30(4), e127-e134. https://doi.org/10.1111/dme.12107