Diabetes Remission Rate after Sleeve Gastrectomy or Roux-en-Y Gastric Bypass; Utilizing Individualized Metabolic Surgery Score for Korean Patients

Abstract

Background: Diabetes has been a rapidly increasing health problem worldwide in the last several decades, especially in East Asia. It is also a chronic disease with numerous complications and socioeconomic effects. Metabolic surgery, derived from bariatric surgery, has been proved superior to medical therapy for the T2DM patients. Objectives: The object of our research is to check out the usefulness of IMS score for Korean patients in determining bariatric surgical procedures. Methods: A total of 135 patients with type 2 diabetes mellitus (T2DM) who underwent sleeve gastrectomy (SG, n=19) and Roux-en-Y gastric bypass (RYGB, n=116) at our institute and had a 1-year follow up (2009-2017) were analyzed for the predictive power of diabetes remission using the IMS scoring system. Results: At the postoperative follow-up of 1 year, the total weight loss was observed in 26.4% of the cohort after surgery. The mean body mass index (BMI) decreased from 39.0 to 28.6 kg/m2, and the mean glycated hemoglobin (HbA1C) decreased from 8.0% to 6.0%. The remission of T2DM (HbA1C<6.5%, off medications) was achieved in 88 (65.2%) T2DM patients. Remission rates showed no significant differences between patients who underwent sleeve gastrectomy and Roux-en-Y gastric bypass (63.2% versus 65.5%; P = 0.84), regardless of T2DM severity. Although there was no statistically significant difference in the remission rate according to the metabolic surgery procedures (P > 0.99 in mild, P = 0.11 in moderate, P > 0.99 in severe IMS score), remission rates were higher in moderate severity patients who underwent Roux-en-Y gastric bypass than in those who underwent sleeve gastrectomy (69.7% versus 37.5%). Conclusion: Our data have two major limitations. One is the low number of patients who underwent sleeve gastrectomy, and the other is the short duration of follow-up period. But there is similar tendency of T2DM remission rate with the cohort of the original study in moderate severity group.