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Metabolic surgery for diabetes treatment: A comparative study of sleeve gastrectomy and gastric bypass
Oral Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S40–S64
Methods: In this cohort study of Taiwanese patients with BMI above 25 who underwent metabolic surgery to ameliorate T2DM between 2007 to 2013, 558 patients (339 young onset and 219 late onset T2DM patients) with minimum of one year follow up were included. Preoperative, peri-operative and postoperative follow up clinical and laboratory data were prospectively collected and compared between two groups. Diabetes remission rate (HbA1c <6.0% without anti-glycemic medication) was primary outcome measure. Results: Young-onset patients had higher preoperative BMI and HbA1c profiles than late-onset patients. Distribution of surgical procedures and major complications were similar between two groups. At one year, young onset group achieved greater weight loss even though it was not statistically significant. A higher complete diabetes remission rate was observed in young onset patients (57.3% vs. 50.2%, p = 0.019). At 5-year, young-onset patients still maintained a higher weight loss (11.8% versus 11.7%, p = 0.002) and higher remission rate (65.3% versus 54.2%, p = 0.04) than late-onset patients. Age at operation, duration of diabetes and C-peptide level were independent predictors of diabetes remission. Remission rate was directly related to extent of weight loss. Multivariate analysis confirmed higher DM remission rates in young-onset group. Conclusion: This report describes the largest, long-term study examining metabolic surgery for young-onset diabetic patients. Metabolic surgery may achieve better and more durable glycemic control in selected young-onset than those with late-onset T2DM patients and early treatment is preferred. OL06-8 Metabolic surgery for diabetes treatment: A comparative study of sleeve gastrectomy and gastric bypass Nawaf ALKHALIFAH1,2, Wei-Jei LEE2, Tan Chun HAI2,3, Shu-Chu CHEN2, Jung-Chien CHEN2, Kong-Han SER2. 1 Department of Surgery, AlAdan Hospital, Kuwait; 2Department of Surgery, Min-Sheng General Hospital, Taiwan; 3Department of Surgery, Khoo Teck Puat Hospital, Singapore Background: Bariatric surgery has gained reputation for its metabolic effect and is increasingly being performed to treat type 2 diabetes mellitus (T2DM). However, there is still a grey area regarding the choice of surgical procedure according to patient characteristics due to inadequate evidences. We aim to compare the efficacy of two most commonly performed bariatric/ metabolic surgeries, sleeve gastrectomy (SG) and gastric bypass (GB) with regards to remission of T2DM after surgery. Methods: Outcomes of 579 (349 women and 230 male) patients who underwent SG (109) or GB (470) for the treatment of T2DM with one year follow-up were assessed. The remission of T2DM after SG or GB surgery was evaluated in matched groups using the ABCD scoring system. The ABCD score is composed of the age, BMI, C-peptide levels and duration of T2DM (years). Results: The weight loss of the SG patient at one year after surgery was similar to the GB patients [26.3(1.1) % vs. 32.6(1.2) %; p = 0.258]. The mean BMI decreased from 35.7(7.2) to 28.3 (3.7) Kg/m2 in SG patients at one year after surgery and decreased from 36.9(7.2) to 26.7(4.5) Kg/m2 in the GB patients. The mean HbA1c decreased from 8.8% to 6.1% of the SG group and from 8.6% to 5.9% of the GB group. Sixty-one (56.0%) patients of the SG group and 300 (63.8%) of the GB group achieved complete remission of T2DM (HbA1c < 6.0%) at one year after surgery without statistical difference. However, GB exhibited significantly better glycemic control than the SG surgery in groups stratified by different ABCD score. At 5-years after surgery, GB had a better remission of T2DM than SG (53.1% vs. 35.3%; p = 0.055). Conclusions: In conclusion, although both SG and GB are effective metabolic surgery, GB carries a higher power on T2DM remission than SG. ABCD score is useful in T2DM patient classification and selection for different procedures.
S55
Laboratory Medicine for Diabetes OL07-1 Time-dependent sensor performance is sustained during 4 years: Accuracy measurement with mean absolute difference (MAD) in continuous glucose monitoring (CGM) Shinichiro KOGA1, Aya KOMIKADO1, Yuko MURAYAMA1, Kazunaga TAKAZAWA1. 1Section for Disorders in Endocrine and Kidney Systems, Department of Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan Background: Mean absolute difference (MAD) is a numerical accuracy measures which is defined as closeness between continuous glucose monitoring (CGM) and corresponding in-time reference blood glucose (BG) measurements 1). However, possible factor affected to MAD is not well documented so far 2). Methods: During May 2012 and March 2016, 55 diabetic patients were unintentionally collected in a single institute and consecutively recorded 96 CGMs with iPro2 (Medtronic MiniMed, Northridge, CA) 2). Analyzed CGMs were assigned to Term 1 (n = 30), 2 (n = 29), and 3 (n = 30) by record starting day [May-Dec 2012,-Nov 2013,-Mar 2016]. Among terms, patient’s age, recoded duration days, sensored BG, effective calibration times by metered BG reference were set as independent variables and MAD was as dependent. Factorial ANOVA was performed with SPSS Statistics version 22.0 (IBM, Chicago, IL). Results: Of consecutive 96 CGM recodings from 55 patients (51.9+/−13.5 years old), 7 were excluded from this study due not to assessed relative coeffficient (r) of MAD; 89 recordings, type 1(45), type 2 (27), fulminant type 1 (13), tumor (insulinoma, etc) peri-operation (3), SPIDDM (1), were subjected to this study. Of total 102,934 times sensored in 89 recordings (1,156.6+/−439.9 times sensored per record), sensor BG was 9.5 +/−2.5 mmol/L, and effectively calibrated 1,706 times by meter BG reference; MAD was 12.24+/−1.51%, r was 0.917+/−0.075. Among three terms [T1, T2, vs T3], patient number was [30, 27, vs 29], patient age was [55.3+/−14.0, 52.4+/−12.5, vs 48.0+/−13.3] years old, and record duration was [4.1+/−0.4, 4.7+/−1.2, vs 6.7 +/−0.7] days per recording. Sensored BG was [9.8+/−2.4, 9.9 +/−2.9, vs 8.7+/−1.9] mmol/L, which was calibrated effectively in [14.7+/−3.3, 17.4+/−7.0, vs 25.4+/−5.5] times per recording; MAD was [11.09+/−2.77, 11.61+/−2.97, vs 13.3+/−5.03] %, and it’s r was [0.932+/−0.114, 0.923+/−0.240, vs 0.905+/−0.173]. Both sensored BG 3) and MAD were not statistically different throughout Terms, whereas patient was younger, record duration was longer, and calibration was most frequent in Term 3. Discussion: Former and no experience users was not different in MAD 4). Relationship between age and frequency of discontinuation 5) was not investigated in this study; Patient’s level of numeracy, literacy, and cognitive function, and poor reimbursement was not investigated. Conclusion: MAD is not affected by patient’s numerical characteristics; within favorable values during 4 years. OL07-3 Validation of a new formula (SMART2D) for estimation of LDL cholesterol in patients with and without diabetes Jeremy HOE1, Ester Chai Kheng YEOH1–3, Chee Fang SUM1–3, Su Chi LIM1–4, Moh Sim WONG5, Aznan OMAR5, Steven TSAI5, Ping Ying HENG5, Subramaniam TAVINTHARAN1–4. 1 Department of Medicine, Khoo Teck Puat Hospital, 2Diabetes Centre, Khoo Teck Puat Hospital, 3Division of Endocrinology, Khoo Teck Puat Hospital, 4Clinical Research Unit, Khoo Teck Puat Hospital, 5 Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore Background: The Friedewald formula, widely used in clinical laboratories to estimate LDL cholesterol (LDL-C), tends to
Methods: In this cohort study of Taiwanese patients with BMI above 25 who underwent metabolic surgery to ameliorate T2DM between 2007 to 2013, 558 patients (339 young onset and 219 late onset T2DM patients) with minimum of one year follow up were included. Preoperative, peri-operative and postoperative follow up clinical and laboratory data were prospectively collected and compared between two groups. Diabetes remission rate (HbA1c <6.0% without anti-glycemic medication) was primary outcome measure. Results: Young-onset patients had higher preoperative BMI and HbA1c profiles than late-onset patients. Distribution of surgical procedures and major complications were similar between two groups. At one year, young onset group achieved greater weight loss even though it was not statistically significant. A higher complete diabetes remission rate was observed in young onset patients (57.3% vs. 50.2%, p = 0.019). At 5-year, young-onset patients still maintained a higher weight loss (11.8% versus 11.7%, p = 0.002) and higher remission rate (65.3% versus 54.2%, p = 0.04) than late-onset patients. Age at operation, duration of diabetes and C-peptide level were independent predictors of diabetes remission. Remission rate was directly related to extent of weight loss. Multivariate analysis confirmed higher DM remission rates in young-onset group. Conclusion: This report describes the largest, long-term study examining metabolic surgery for young-onset diabetic patients. Metabolic surgery may achieve better and more durable glycemic control in selected young-onset than those with late-onset T2DM patients and early treatment is preferred. OL06-8 Metabolic surgery for diabetes treatment: A comparative study of sleeve gastrectomy and gastric bypass Nawaf ALKHALIFAH1,2, Wei-Jei LEE2, Tan Chun HAI2,3, Shu-Chu CHEN2, Jung-Chien CHEN2, Kong-Han SER2. 1 Department of Surgery, AlAdan Hospital, Kuwait; 2Department of Surgery, Min-Sheng General Hospital, Taiwan; 3Department of Surgery, Khoo Teck Puat Hospital, Singapore Background: Bariatric surgery has gained reputation for its metabolic effect and is increasingly being performed to treat type 2 diabetes mellitus (T2DM). However, there is still a grey area regarding the choice of surgical procedure according to patient characteristics due to inadequate evidences. We aim to compare the efficacy of two most commonly performed bariatric/ metabolic surgeries, sleeve gastrectomy (SG) and gastric bypass (GB) with regards to remission of T2DM after surgery. Methods: Outcomes of 579 (349 women and 230 male) patients who underwent SG (109) or GB (470) for the treatment of T2DM with one year follow-up were assessed. The remission of T2DM after SG or GB surgery was evaluated in matched groups using the ABCD scoring system. The ABCD score is composed of the age, BMI, C-peptide levels and duration of T2DM (years). Results: The weight loss of the SG patient at one year after surgery was similar to the GB patients [26.3(1.1) % vs. 32.6(1.2) %; p = 0.258]. The mean BMI decreased from 35.7(7.2) to 28.3 (3.7) Kg/m2 in SG patients at one year after surgery and decreased from 36.9(7.2) to 26.7(4.5) Kg/m2 in the GB patients. The mean HbA1c decreased from 8.8% to 6.1% of the SG group and from 8.6% to 5.9% of the GB group. Sixty-one (56.0%) patients of the SG group and 300 (63.8%) of the GB group achieved complete remission of T2DM (HbA1c < 6.0%) at one year after surgery without statistical difference. However, GB exhibited significantly better glycemic control than the SG surgery in groups stratified by different ABCD score. At 5-years after surgery, GB had a better remission of T2DM than SG (53.1% vs. 35.3%; p = 0.055). Conclusions: In conclusion, although both SG and GB are effective metabolic surgery, GB carries a higher power on T2DM remission than SG. ABCD score is useful in T2DM patient classification and selection for different procedures.
S55
Laboratory Medicine for Diabetes OL07-1 Time-dependent sensor performance is sustained during 4 years: Accuracy measurement with mean absolute difference (MAD) in continuous glucose monitoring (CGM) Shinichiro KOGA1, Aya KOMIKADO1, Yuko MURAYAMA1, Kazunaga TAKAZAWA1. 1Section for Disorders in Endocrine and Kidney Systems, Department of Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan Background: Mean absolute difference (MAD) is a numerical accuracy measures which is defined as closeness between continuous glucose monitoring (CGM) and corresponding in-time reference blood glucose (BG) measurements 1). However, possible factor affected to MAD is not well documented so far 2). Methods: During May 2012 and March 2016, 55 diabetic patients were unintentionally collected in a single institute and consecutively recorded 96 CGMs with iPro2 (Medtronic MiniMed, Northridge, CA) 2). Analyzed CGMs were assigned to Term 1 (n = 30), 2 (n = 29), and 3 (n = 30) by record starting day [May-Dec 2012,-Nov 2013,-Mar 2016]. Among terms, patient’s age, recoded duration days, sensored BG, effective calibration times by metered BG reference were set as independent variables and MAD was as dependent. Factorial ANOVA was performed with SPSS Statistics version 22.0 (IBM, Chicago, IL). Results: Of consecutive 96 CGM recodings from 55 patients (51.9+/−13.5 years old), 7 were excluded from this study due not to assessed relative coeffficient (r) of MAD; 89 recordings, type 1(45), type 2 (27), fulminant type 1 (13), tumor (insulinoma, etc) peri-operation (3), SPIDDM (1), were subjected to this study. Of total 102,934 times sensored in 89 recordings (1,156.6+/−439.9 times sensored per record), sensor BG was 9.5 +/−2.5 mmol/L, and effectively calibrated 1,706 times by meter BG reference; MAD was 12.24+/−1.51%, r was 0.917+/−0.075. Among three terms [T1, T2, vs T3], patient number was [30, 27, vs 29], patient age was [55.3+/−14.0, 52.4+/−12.5, vs 48.0+/−13.3] years old, and record duration was [4.1+/−0.4, 4.7+/−1.2, vs 6.7 +/−0.7] days per recording. Sensored BG was [9.8+/−2.4, 9.9 +/−2.9, vs 8.7+/−1.9] mmol/L, which was calibrated effectively in [14.7+/−3.3, 17.4+/−7.0, vs 25.4+/−5.5] times per recording; MAD was [11.09+/−2.77, 11.61+/−2.97, vs 13.3+/−5.03] %, and it’s r was [0.932+/−0.114, 0.923+/−0.240, vs 0.905+/−0.173]. Both sensored BG 3) and MAD were not statistically different throughout Terms, whereas patient was younger, record duration was longer, and calibration was most frequent in Term 3. Discussion: Former and no experience users was not different in MAD 4). Relationship between age and frequency of discontinuation 5) was not investigated in this study; Patient’s level of numeracy, literacy, and cognitive function, and poor reimbursement was not investigated. Conclusion: MAD is not affected by patient’s numerical characteristics; within favorable values during 4 years. OL07-3 Validation of a new formula (SMART2D) for estimation of LDL cholesterol in patients with and without diabetes Jeremy HOE1, Ester Chai Kheng YEOH1–3, Chee Fang SUM1–3, Su Chi LIM1–4, Moh Sim WONG5, Aznan OMAR5, Steven TSAI5, Ping Ying HENG5, Subramaniam TAVINTHARAN1–4. 1 Department of Medicine, Khoo Teck Puat Hospital, 2Diabetes Centre, Khoo Teck Puat Hospital, 3Division of Endocrinology, Khoo Teck Puat Hospital, 4Clinical Research Unit, Khoo Teck Puat Hospital, 5 Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore Background: The Friedewald formula, widely used in clinical laboratories to estimate LDL cholesterol (LDL-C), tends to