Does the duration of diabetes prior to bariatric surgery impact on the outcome?

Background: Bariatric surgery has emerged as an effective way of treating type 2 diabetes. However, whether the duration of diabetes prior to surgery has an impact on the resolution/remission of type 2 diabetes after surgery is still a question to be answered. The aim of this study was to compare the outcomes of resolution/remission of diabetes in patients who were known diabetic for less than and more than 5 years prior to surgery.

Methods: A retrospective review of a prospectively maintained database was conducted on all type 2 diabetic patients undergoing laparoscopic bariatric surgery at a regional NHS bariatric centre between 2008 and 2014. Patient demographics, operative details, HbA1c and duration of type 2 diabetes before surgery and weight loss were analysed.

Results: 103 type 2 diabetic patients who underwent bariatric surgery were identified. 36M:67F. Mean age 49 years (range:28-63 years). 7 laparoscopic adjustable gastric band (LAGB); 51 laparoscopic sleeve gastrectomy (LSG) and45 laparoscopic gastric bypass (LGB). 53 patients were identified who had type2 diabetes for more than 5 years prior to surgery (Group A) and 50 patients had diabetes for less than 5 years (Group B). Mean initial HbA1c for group A was higher (8.0%) compared to group B (7.3%). Group B had better HbA1c control than group A after surgery. At 6 months: 6.5% (group A) and 5.9%(group B); 12 months: 6.3% vs 6.0%. After 18 months, on subsequent six monthly checks the mean HbA1c was 4-11% lower than group A until 42months (Graph 1). Group A patients performed better in weight reduction(Graph 2).

Conclusion: The patients who were diabetic for less than 5 years performed better in terms of resolution/remission of diabetes compared to those who were known diabetic for longer.