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Changes in Insulin Dependence after Bariatric Surgery
*Ali Ardestani1, *David B Rhoads2, Ali Tavakkoli1 1Brigham and Women's Hospital, Boston, MA;2Massachusetts General Hospital, Boston, MA
Objective:To evaluate the impact of bariatric surgery on insulin dependent patients with Type-2 Diabetes Mellitus (T2DM) Design:Cohort study from prospectively collected Bariatric Outcomes Longitudinal Database (BOLD) Setting:National cohort Patients:Patients with insulin dependant T2DM who have undergone bariatric surgery during 2007-2010 Interventions:Roux-en-Y Gastric Bypass Surgery (RYGB) and Laparoscopic Adjustable Gastric Banding (LAGB) Main Outcome Measures:Insulin independence and Excess Weight Loss (%EWL) Results:We identified113,638 adult patients who had undergone bariatric surgery. 10% had insulin-dependent T2DM, from which we analyzed 5,225 patients who had at least one year of follow up. At 12 months 62% of RYGB and 34% LAGB patients were off insulin (Figure 1). Regression models were developed to identify factors that contribute to insulin independence at 1 and 12-months postoperatively (Table 1). At both time points, RYGB was a strong predictor of insulin independence. For LAGB, insulin independence appeared linked to weight loss, while for RYGB the effect appeared to be weight independent in early stages. Conclusions:With increasing utility of bariatric procedures for treatment of T2DM, RYGB appears to offer a greater chance of insulin independence (over 60% at 1 year), and may be the procedure of choice.
Table 1. Factors that impact insulin independence after bariatric surgery. | Early (1 month) | Late (12 months) | Odds Ratio (95% CI) | P value | Odds Ratio (95% CI) | P value | Sex (%Male) | 1.02 (0.88-1.19) | NS | 0.85 (0.75-0.96) | 0.009 | Race (%Caucasian) | 0.94 (0.83-1.10) | NS | 0.95 (0.85-1.05) | NS | Procedure (%RYGB) | 2.21 (1.88-2.61) | <0.001 | 1.57 (1.34-1.84) | <0.001 | Age (years) | 0.98 (0.98 -1.00) | <0.001 | 0.98 (0.98-0.99) | <0.001 | Preoperative BMI (kg/m2) | 1.00 (0.99-1.01) | NS | 1.01 (1.00-1.02) | 0.033 | EBWL at 1 month (%) | 1.03 (1.02-1.04) | <0.001 | NA | NA | EBWL at 12 months (%) | NA | NA | 1.02 (1.02-1.03) | <0.001 |
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