A.MOH1, C.H.TAN1, A.CHENG1, B.C.TAN1, D.NG1, S.C.LIM2
Khoo Teck Puat Hospital1, Admiralty Medical Centre2
Weight loss induced by metabolic surgery plays a crucial role in diabetes remission in people with severe obesity. However, diabetes reversal does not occur in all, albeit substantial postoperative weight loss. We hypothesize that the time taken to achieve significant weight loss after metabolic surgery is a critical determinant of diabetes remission.
Adults with type 2 diabetes (n=104; age:46±9 years, 46.2% men, body mass index:40.0±6.7 kg/m²) were categorized by the time points at which significant weight loss (i.e. ≥20% of total weight loss) was first attained after metabolic surgery (≤3, >3?6, or >6−12 months) or not attained throughout the study period (reference). The primary outcome was complete diabetes remission, defined as HbA1c≤6% with no glucose-lowering medication at one-year postoperatively.
Forty-four percent (n=46) of the subjects experienced complete diabetes remission (‘remitters’) post-surgery. The remitters displayed greater cumulative percentage weight loss over time than the non-remitters (P<0.05); and they were characterized by younger age, greater β-cell function and shorter diabetes duration. Across the different time points, rapid significant weight loss at ≤3 months after surgery was robustly associated with diabetes remission in the unadjusted model (risk ratio:3.28, 95% CI:1.62–6.62, P=0.001). The association persisted after adjustment for baseline age, diabetes duration, HbA1c, and insulin treatment (risk ratio:3.84, 95% CI:1.82–8.11, P<0.001).
Substantial weight reduction within the first 3 months post-metabolic surgery may represent the ‘golden window’ for successful diabetes remission. Early administration of adjunctive interventions to further promote weight loss after surgery may bring about favourable diabetes outcome.