the study by Richard Perugini, MD, and colleagues from the University of Massachusetts Medical Center in Worcester, involved 137 people with diabetes who were severely obese (body mass index ranged from 33 to 75 kg/m²).
All patients required medication for glycemic control and had achieved HbA1c levels under 7.5% prior to undergoing Roux-en-Y gastric bypass surgery.
In 46% of patients, diabetes had remitted at 40 days (remission was defined by the researchers as the withdrawal of diabetic medications). That rose to 57% at 180 days and 70% at 1 year.
For all subjects (those who were no longer on medication and those who were), mean HbA1c level was 5.9% at 40 days, 6.0% at 180 days, and 6.1% at 1 year, Dr. Perugini reported. At 1 year, subjects no longer taking medication had a better mean HbA1c level than those taking medication (5.7% vs 6.3%).
Weight loss was similar in those who experienced remission and those who did not (23% to 27% at 6 weeks and 58% to 60% at 1 year), suggesting that the remission of diabetes is independent of weight loss, said Dr. Perugini.
Dr. Perugini noted that, “The majority of patients who went off their medications were off by 6 weeks.” At that point, the only phenomena at play were independent of weight loss, such as the incretin response, he explained.
The researchers compared the remission and nonremission groups and found that the 2 strongest predictors of postsurgical remission were baseline insulin use and baseline homeostasis model assessment disposition index (HOMA-DI), a measure of residual beta cell function. Patients with a HOMA-DI greater than 30% of normal at baseline had a 4-fold increased chance of remission, and patients who achieved adequate baseline glycemic control without using insulin had an 8-fold chance of remission, he said.
“Patients who did not require insulin and who had a HOMA disposition index greater than 30% had a 98% chance of remission, whereas patients…who required insulin and who had a HOMA disposition index below 30% only had an 18% chance of remission,” he said.
Dr. Perugini said in a statement that, “The study shows that beta cell function…and insulin dependence, not initial weight or subsequent weight loss, are the greatest predictors of potential diabetes remission after gastric bypass.”
Health-e-Solutions comment: The early hype regarding hyperbaric surgery is beginning to wear thin as more data becomes available. It may still be a viable treatment for some obese diabetics, but the benefits are best with those who still had sufficient beta cell function. The Health-e-Solutions lifestyle is still our first choice for treatment and management of diabetes.
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