Background: Metabolic-bariatric surgery (MBS) leads to durable weight loss and significant metabolic improvement in type 2 diabetes mellitus (T2DM) patients with obesity. However, data on durability of control is often lacking in Asia.
Aim: We report 5-year glycemic and metabolic outcomes in a T2DM cohort who had MBS from 2008-2012 at a tertiary center in Singapore.
Methodology: Patient demographics and biochemical parameters were retrieved from a web-based data repository. DM remission was defined as HbA1c ≤6% without DM medications.
Results: There were 59 patients with a mean age of 43.0±9.5 years and 37.3% were males (Table 1). Most (76.3%) had gastric bypass while 23.7% had sleeve gastrectomy. Baseline mean weight and BMI were 114.4±27.4 kg and 42.5±10.5 kg/m2 respectively. Mean weight loss of 26% was achieved at 1 year and sustained over 5 years. Mean HbA1c decreased from 8.3% to 5.8% and 6.3% at 1 and 5 years respectively, with use of fewer DM, anti-hypertensive and lipid-lowering medications. At 5 years, 18 of 43 (41.9%) patients achieved sustained remission of diabetes with 6 (14.0%) having relapse of DM after initial remission at 1 year.
Conclusion: MBS is effective therapy for obesity and DM with durable glycemic and metabolic control associated with lower medication use over 5 years in this Asian population.
Table 1. Characteristics of subjects at baseline and over 5-year follow up
| Patient characteristics | Pre-surgery (n=59) | 12 months (n=47) | 24 months (n=40) | 36 months (n=37) | 48 months (n=38) | 60 months (n=43) |
| Gender Male Female | 22(37.3%) 37(62.7%) | NA | NA | NA | NA | NA |
| Age (years) | 43.0 ± 9.5 | NA | NA | NA | NA | NA |
| Ethnicity Chinese Malay Indian Other | 24 (40.7%) 20 (33.9%) 14 (23.7%) 1 (1.7%) | NA | NA | NA | NA | NA |
| Diabetes mellitus duration (months) | 92.1±96.3 | NA | NA | NA | NA | NA |
| Types of surgery Sleeve gastrectomy Mini gastric bypass Roux-en-Y gastric bypass | 14(23.7%) 16(27.1%) 29(49.2%) | NA | NA | NA | NA | NA |
| Weight (kg) | 114.4±27.4 | 84.9±20.5* | 84.5±21.0* | 87.5±23.0* | 83.0±19.9* | 83.8±21.5* |
| Body Mass Index (BMI) (%) | 42.5±10.5 | 31.9±8.3* | 31.3±7.4* | 32.5±8.2* | 31.3±8.06* | 32.0±8.67* |
| Systolic blood pressure (mmHg) | 127.0±14.6 | 125.6±17.3 | 125.8±18.2 | 130.2±17.7 | 129.7±13.3 | 135.4±19.2 |
| Diastolic blood pressure (mmHg) | 77.0±9.5 | 77.5±11.8 | 78.3±10.8 | 80.5±8.7 | 78.8±10.7 | 75.8±8.7 |
| Fasting blood glucose (mmol/L) | 8.51±3.12 | 5.51±1.93* | 5.99±2.11* | 6.59±2.57* | 6.72±2.51* | 6.73±2.55* |
| HbA1c (%) | 8.32±1.38 | 5.82±0.82* | 6.09±1.09* | 6.51±1.31* | 6.53±1.11* | 6.32±1.02* |
| Lipid panel (mmol/L) Total cholesterol LDL Triglyceride HDL | 4.56±0.88 2.75±0.81 1.69±0.74 1.05±0.26 | 4.77±0.94 2.83±0.61 1.19±0.56* 1.32±0.29* | 4.81±0.77* 2.84±0.73 1.30±0.51* 1.46±0.54* | 4.79±0.86* 2.78±0.70 1.42±0.68* 1.37±0.32* | 4.54±0.91 2.52±0.80 1.41±0.76* 1.38±0.28* | 4.17±0.52 2.28±0.45 1.30±0.70* 1.30±0.28* |
| Number of DM medications | 1.90±1.03 | 0.42±0.79* | 0.31±0.68* | 0.45±0.93* | 0.57±1.10* | 0.60±1.19* |
| Antihypertensive medications | 1.64±1.21 | 0.42±0.70* | 0.39±0.72* | 0.37±0.79* | 0.40±0.83* | 0.45±0.95* |
| Lipid-lowering medications | 0.81±0.57 | 0.17±0.38* | 0.25±0.44* | 0.31±0.50* | 0.27±0.49* | 0.33±0.51* |
| Diabetes remission (n) | NA | 28 | 24 | 12 | 12 | 18 |
| Patient characteristics | Pre-surgery (n=59) | 12 months (n=47) | 24 months (n=40) | 36 months (n=37) | 48 months (n=38) | 60 months (n=43) |
| Gender Male Female | 22(37.3%) 37(62.7%) | NA | NA | NA | NA | NA |
| Age (years) | 43.0 ± 9.5 | NA | NA | NA | NA | NA |
| Ethnicity Chinese Malay Indian Other | 24 (40.7%) 20 (33.9%) 14 (23.7%) 1 (1.7%) | NA | NA | NA | NA | NA |
| Diabetes mellitus duration (months) | 92.1±96.3 | NA | NA | NA | NA | NA |
| Types of surgery Sleeve gastrectomy Mini gastric bypass Roux-en-Y gastric bypass | 14(23.7%) 16(27.1%) 29(49.2%) | NA | NA | NA | NA | NA |
| Weight (kg) | 114.4±27.4 | 84.9±20.5* | 84.5±21.0* | 87.5±23.0* | 83.0±19.9* | 83.8±21.5* |
| Body Mass Index (BMI) (%) | 42.5±10.5 | 31.9±8.3* | 31.3±7.4* | 32.5±8.2* | 31.3±8.06* | 32.0±8.67* |
| Systolic blood pressure (mmHg) | 127.0±14.6 | 125.6±17.3 | 125.8±18.2 | 130.2±17.7 | 129.7±13.3 | 135.4±19.2 |
| Diastolic blood pressure (mmHg) | 77.0±9.5 | 77.5±11.8 | 78.3±10.8 | 80.5±8.7 | 78.8±10.7 | 75.8±8.7 |
| Fasting blood glucose (mmol/L) | 8.51±3.12 | 5.51±1.93* | 5.99±2.11* | 6.59±2.57* | 6.72±2.51* | 6.73±2.55* |
| HbA1c (%) | 8.32±1.38 | 5.82±0.82* | 6.09±1.09* | 6.51±1.31* | 6.53±1.11* | 6.32±1.02* |
| Lipid panel (mmol/L) Total cholesterol LDL Triglyceride HDL | 4.56±0.88 2.75±0.81 1.69±0.74 1.05±0.26 | 4.77±0.94 2.83±0.61 1.19±0.56* 1.32±0.29* | 4.81±0.77* 2.84±0.73 1.30±0.51* 1.46±0.54* | 4.79±0.86* 2.78±0.70 1.42±0.68* 1.37±0.32* | 4.54±0.91 2.52±0.80 1.41±0.76* 1.38±0.28* | 4.17±0.52 2.28±0.45 1.30±0.70* 1.30±0.28* |
| Number of DM medications | 1.90±1.03 | 0.42±0.79* | 0.31±0.68* | 0.45±0.93* | 0.57±1.10* | 0.60±1.19* |
| Antihypertensive medications | 1.64±1.21 | 0.42±0.70* | 0.39±0.72* | 0.37±0.79* | 0.40±0.83* | 0.45±0.95* |
| Lipid-lowering medications | 0.81±0.57 | 0.17±0.38* | 0.25±0.44* | 0.31±0.50* | 0.27±0.49* | 0.33±0.51* |
| Diabetes remission (n) | NA | 28 | 24 | 12 | 12 | 18 |
Continuous data as mean ± SD; categorical data as n (%)
* Presence of significant difference when compared to pre-surgery data (p<0.05)
Z. Liew: None. A. Maung: None. S. Ganguly: Advisory Panel; Self; Novo Nordisk Inc.. P. Lee: None. K. Tham: None.