Type 2 diabetes (T2D) is a growing public health challenge that affects 422 million people and increases morbidity and mortality (1). Obesity is a major driver of the T2D pandemic (2). T2D is frequently associated with progressive decline in β-cell function in the setting of insulin resistance, necessitating escalation of pharmacotherapy that often culminates in insulin treatment (3). Weight loss can potentially reverse this trajectory and induce remission of T2D (3,4). Metabolic surgery (MS) is the most efficacious treatment for T2D remission, with its initial effects largely mediated by reduced caloric intake and weight loss (5,6). Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most common MS procedures worldwide, with the latter being the most common MS in the U.S. (7,8). In a randomized controlled trial, RYGB achieved T2D remission in 75% of patients at 2 years (defined as HbA1c <6.5% and fasting glucose <100 mg/dL in the absence of glucose-lowering medication), which declined to 25% at 10 years (4). The HbA1c cutoff of <6.5%, off glucose-lowering medications, for T2D remission is concordant with the recent American Diabetes Association consensus definition of remission (9). Using a stricter HbA1c cutoff of <6% for T2D remission, 42% of patients undergoing RYGB and 37% of patients undergoing SG achieve remission 1 year after surgery, which declines to 29% (RYGB) and 23% (SG) at 5 years (10). Weight regain is associated with relapse of T2D (4,10,11). Indicators of more advanced T2D, including increasing age, duration of T2D, number of glucose-lowering medications, baseline HbA1c, and insulin use, predict T2D nonremission and are incorporated into predictive tools such as the diabetes remission (DiaRem) score and advanced DiaRem score (12).
…. more: Diabetes Journals (ADA) (Quelle/Source)