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Development of Obesity-Associated Comorbidities Post Bariatric Surgery with a Special Focus on Diabetes Remission and Short-Term Relapse
received 10 July 2017
revised 18 September 2017
accepted 18 September 2017
08 November 2017 (online)
Purpose The purpose of this study is to study a heterogeneous group of obese patients undergoing Bariatric surgery(BS) and its impact on glycemic control. Secondary endpoints include changes in lipid profile and albuminuria. BS has shown to effectively reduce body-weight. However, the impact on obesity-related comorbidities varies strongly between individuals. Especially postoperative short- and long-term improvement of Diabetes is an active area of investigation.
Methods We conducted a retrospective analysis from baseline to 24 months post bariatric surgery in our interdisciplinary obesity outpatient-clinic. Follow-up data was collected from 215 patients who had undergone either Roux-en-Y gastric bypass or Sleeve Gastrectomy. The prevalence of and changes in the major obesity-related comorbidities and concurrent medication were assessed.
Results Standard parameters of diabetic control showed a U-shaped curve with initial improvement after six months, but with a gradual worsening after the first year of follow-up. Weight loss resulted in dose reduction of oral antidiabetic medication and insulin in 85% and 100% of patients, respectively. With weight loss, a significant improvement in lipid profile one year after surgery was seen. Subgroup analysis demonstrated gender- and age-dependent differences in overall benefit.
Conclusions Current data on diabetes remission might be too optimistic and close follow-up should be provided to prevent gradual worsening of glucose metabolism after BS.
* These authors contributed equally to this work.
- 1 Von Lengerke T, Krauth C. Economic costs of adult obesity: A review of recent European studies with a focus on subgroup-specific costs. Maturitas [Internet] 2011; 69 (03) 220-229
- 2 Schroeder R, Garrison Jr. JM, Johnson MS. Treatment of adult obesity with bariatric surgery. Am Fam Physician [Internet] 2011; 84 (07) 805-814 Available from http://www.ncbi.nlm.nih.gov/pubmed/22010619
- 3 Knop FK, Taylor R. Mechanism of metabolic advantages after bariatric surgery: It’s all gastrointestinal factors versus it’s all food restriction. Diabetes Care 2013; 36 (SUPPL.2): 287-291
- 4 Ahn SM, Pomp A, Rubino F. Metabolic surgery for type 2 diabetes. Annals of the New York Academy of Sciences. 2010; 1212: E37-E45
- 5 Thorell A, Hagström-Toft E. Treatment of diabetes prior to and after bariatric surgery. J Diabetes Sci Technol [Internet] 2012; 6 (05) 1226-1232 Available from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3570858&tool=pmcentrez&rendertype=abstract
- 6 Sjöström L, Peltonen M, Jacobson P. et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA [Internet] 2014; 311 (22) 2297-2304 Available from http://www.ncbi.nlm.nih.gov/pubmed/24915261
- 7 Scopinaro N, Marinari GM, Camerini GB. et al. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care [Internet] 2005; Oct [cited 2017 Sep 5] 28: 2406-2411 Available from http://www.ncbi.nlm.nih.gov/pubmed/16186271
- 8 Brethauer SA, Aminian A, Romero-Talamás H. et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013; 258 (04) 628-36-37
- 9 Mingrone G, Panunzi S, De Gaetano A. et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med [Internet] 2012; 366 (17) 1577-1585 Available from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=22449317&retmode=ref&cmd=prlinks%5Cnpapers2://publication/doi/10.1056/NEJMoa1200111
- 10 Aarts EO, van Wageningen B, Janssen IMC. et al. Prevalence of Anemia and Related Deficiencies in the First Year following Laparoscopic Gastric Bypass for Morbid Obesity. J Obes [Internet] 2012; [cited 2017 Sep 16] 2012: 193705 Available from http://www.hindawi.com/journals/jobe/2012/193705/
- 11 Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg [Internet] 2008; Mar 23 [cited 2017 Sep 16] 18: 288-293 Available from http://link.springer.com/10.1007/s11695-007-9310-0
- 12 English E, Idris I, Smith G. et al. The effect of anaemia and abnormalities of erythrocyte indices on HbA1c analysis: a systematic review. Diabetologia [Internet] 2015; Jul 21 [cited 2017 Sep 16] 58: 1409-1421 Available from http://www.ncbi.nlm.nih.gov/pubmed/25994072
- 13 Noria SF, Grantcharov T. Biological effects of bariatric surgery on obesity-related comorbidities. Can J Surg. 2013; 56 (01) 47-57
- 14 Inge TH, Courcoulas AP, Jenkins TM et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. N Engl J Med [Internet] 2015 151106070015003. Available from http://www.nejm.org/doi/abs/10.1056/NEJMoa1506699 %5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/26544725
- 15 Sjöström L, Lindroos A-K, Peltonen M. et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med [Internet] 2004; 351 (26) 2683-2693 Available from http://www.ncbi.nlm.nih.gov/pubmed/15616203
- 16 Schauer PR, Kashyap SR, Wolski K. et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. New England Journal of Medicine. 2012; 366 p 1567-1576
- 17 Mahdy Ali K, Wonnerth A, Huber K. et al. Cardiovascular disease risk reduction by raising HDL cholesterol--current therapies and future opportunities. Br J Pharmacol [Internet] 2012; 167 (06) 1177-1194 Available from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3504986&tool=pmcentrez&rendertype=abstract
- 18 Athyros VG, Tziomalos K, Karagiannis A. et al. Cardiovascular benefits of bariatric surgery in morbidly obese patients. Obes Rev [Internet] 2011; 12 (07) 515-524 Available from http://www.ncbi.nlm.nih.gov/pubmed/21348922
- 19 Laville M. [Renal consequences of obesity]. Néphrologie & thérapeutique [Internet] 2011; 7 (02) 80-85 Available from http://www.ncbi.nlm.nih.gov/pubmed/21208837
- 20 Othman M, Kawar B, El Nahas AM. Influence of obesity on progression of non-diabetic chronic kidney disease: A retrospective cohort study. Nephron - Clin Pract 2009; 113: 1
- 21 Sweiss N, Sharma K. Adiponectin effects on the kidney. In: Best Practice and Research: Clinical Endocrinology and Metabolism 2014; p 71-79
- 22 Carlsson LMS, Romeo S, Jacobson P. et al. The incidence of albuminuria after bariatric surgery and usual care in Swedish Obese Subjects (SOS): a prospective controlled intervention trial. Int J Obes (Lond) [Internet] 2015; 39 (01) 169-175 Available from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4285618&tool=pmcentrez&rendertype=abstract
- 23 Currie A, Chetwood A, Ahmed AR. Bariatric surgery and renal function. Obesity Surgery. 2011; p 528-539
- 24 Jordan J, Yumuk V, Schlaich M. et al. Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and difficult to treat arterial hypertension. J Hypertens. 2012; 30 (06) 1047-1055
- 25 Schauer DP, Arterburn DE, Livingston EH. et al. Decision modeling to estimate the impact of gastric bypass surgery on life expectancy for the treatment of morbid obesity. Arch Surg [Internet] 2010; 145 (01) 57-62 Available from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2862372&tool=pmcentrez&rendertype=abstract