Introduction:
In Asia, the rate of metabolic-bariatric surgery (MBS) has grown rapidly in parallel with rising obesity and type 2 diabetes mellitus (T2DM) rates.
Objectives:
To identify factors that influence glycemic outcomes and diabetes remission at 12 months after sleeve gastrectomy (SG) or gastric bypass (GB) in a multi-ethnic Asian cohort.
Methods:
Data from patients with T2DM who had SG (41%) or GB (59%) at a single centre in Singapore with at least one year follow-up were analysed. Remission was defined as HbA1c of 6.0% or lower without diabetes medications. Analysis involved binary logistic regression to identify predictors and general linear regression was used to identify independent variables associated with glycemic improvement after MBS.
Results:
207 patients were included in the study. Mean age was 45.7 years, baseline BMI 41.2 kg/m2, HbA1c 8.3% and duration of diabetes was 8.6 years. Diabetes remission was achieved in 73 patients (51.8%) at one year. Duration of diabetes (OR 0.87, 95% CI: 0.79-0.96, p=0.005) and baseline HbA1c (OR 0.37, 95% CI: 0.20-0.69, p=0.001) were significant pre-operative factors associated with diabetes remission. At 12 months, total percentage weight loss was 24.0% after SG and 25.8% after GB (p=0.156). Greater reduction in HbA1c was seen with GB compared to SG (2.7% vs. 1.9%, p=0.001), which remain significant even after adjustment for weight loss, age, BMI, baseline HbA1c and duration of diabetes (p=0.011). Weight loss at 12 months also correlates with HbA1c reduction. Ethnicity was not significant factor in predicting diabetes remission, glycemic control or weight loss after MBS.
Conclusion:
Baseline HbA1c levels and duration of diabetes are independent factors that predict diabetes remission after MBS. GB is more effective in controlling T2DM compared to SG despite similar weight loss. Ethnicity does not play a significant role in modulating weight loss or glycemic response to MBS.