Reversal of Diabetes Mellitus in Obese Individuals following Bariatric Surgery-Single Center Experience at a Tertiary Care Hospital in Sri-Lanka

Obesity is a chronic progressive disease characterized by an increase in body fat stores.Diabetes mellitus has become another major pandemic causing huge cost to the healthcare system.There is a well-established link between the development of T2DM and being overweight or obese.Bariatric surgery is a well-recognized, effective treatment option for patients with obesity and T2DM where advantages of bariatric surgery go beyond the simple weight loss.In order to evaluate the short-term (at 1year) and long term (at 5years) remission of diabetes following bariatric surgery, we conducted a retrospective analysis among the patients who underwent the procedure at Colombo South Teaching Hospital, Sri Lanka between 2013-2020.Diagnosis and remission of diabetes were defined by ADA criteria.Among the 245 patients who underwent bariatric surgery, 109 (44.4%) had pre-operative T2DM, 44 (17.9%) had IFG, and 92 (37.7%) had complete normoglycemia with FBS <100mg/dl and HbA1C <5.6%.Pre-operatively 75 (68.9%)were females and 34 (31.1%) were males.Only the cohort of patients with pre-operative T2DM (n=109) was included in the outcome analysis.The pre-operative population with diabetes had following mean age -40±10years, females-71.6%(n=78), mean weight -115.8±24.4kg(range = 75-204), mean BMI -45.4±7.4kg/m2(range = 31.2-68.1),mean HbA1c -8.5±1.6%,mean FPG-140±47mg/dL and average duration of diabetes -3.5 years.The averages of FPG and HbA1C for the IFG group were 106±11mg/dl and 5.8±0.6%respectively.The pre-operative non-diabetic population had a mean weight of 121.5±35kg (range=74-181), mean BMI of 45.1±6.5kg/m2,mean FPG of 95.8±18mg/dl and mean HbA1c of 5.5±0.6%.Post-operative 1 year analysis of pre-operative diabetes group revealed a mean weight of 81.1kg±16.9(range-52-140), mean BMI of 32.2kg/m2±5.8with a mean weight loss of 32.1±14.8kg.Mean HbA1c and FPG improved to 5.5%±0.9 and 99±23mg /dl.87.1% achieved diabetes remission with 58.7% reaching FPG of <100mg/dl and 28.4% reaching IFG. 15 (13.9%) had persistent diabetes.95.4% (n-44) of pre-operative IFG patients achieved FPG of <100mg/dl while 2 (4.6%) remained in the IFG category.Mean FPG and HbA1c declined to 90±16mg/dl and 5.2±0.5% respectively.1 year Diabetes Remission rate males and females were 90.3% and 84.6% respectively and the long-term diabetes remission rate was 80% among males and 91% among females.Separate analysis of 55 patients for 5year long term data revealed a mean weight, BMI and weight loss of 84 kg±13.6,34.1 kg/m2±4.9 and 41.0kg±19.2respectively.Mean FPG (102mg/dl) and HbA1C (5.7%±0.89)improved by 29.2% and 32.9% respectively.However, there was an upward trend of HbA1c, mean weight and mean BMI when compared to 1year value.Diabetes remission at 5 years was seen in 41 (74.5%) achieving FPG of <100mg/dl in 25 (45.4%) and IFG in 16 (29%) with 14 (25.5%)having diabetes including new occurrence of diabetes in 1 patient.Age of onset of diabetes, gender, pre-operative weight, and duration of diabetes had an impact on diabetes reversal.Pre-operative BMI had no impact on diabetes remission.(p=0.35).RYGB had better reversal of diabetes where LSG and LMGB had similar outcome.In conclusion, bariatric surgery is associated with both short-and long-term diabetes remission.