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Gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus patients with BMI less than  30 kg/m2: ABCD score can predict the success of treatment


Metabolic surgery is a novel therapy for mild obesity ( BMI 30-35 Kg/m2 ) in type 2 diabetes mellitus ( T2DM ) patients. The ABCD score, which comprise age, BMI, C-peptide level, and duration of type 2 diabetes ( years ), was reported as useful in predicting the success of diabetes treatment using metabolic surgery.

A study has examined gastric bypass and sleeve gastrectomy as a salvage treatment for non-obese ( BMI less than  30 kg/m2 ) diabetic patients and has evaluated the role of ABCD scores.

During the period 2007-2013, 512 ( 71.2 % ) of 711 type 2 diabetes patients enrolled in a metabolic surgical program had at least 1-year follow-up were recruited.
Clinical data and outcomes of 80 ( 15.6 % ) patients with BMI less than 30 kg/m2 were compared with those of the other 432 ( 84.4 % ) patients with BMI  greater than or equal to  30 kg/m2.

Complete remission was defined as glycated haemoglobin ( HbA1c ) less than or equal to  6 %, and partial remission was defined as HbA1c less than  6.5 %. A binary logistic regression was used to identify predictors of type 2 diabetes mellitus remission.

Mean age of the 80 non-obese diabetic patients was 47.7 ± 9.1 years, and mean HbA1c and disease duration were 9.1 ± 1.8% and 6.5 ± 5.1 years, respectively.

Mean total body weight loss was 17.1 ± 7.4% at 1 year, and mean BMI decreased from 26.9 ± 2.2 to 22.7 ± 2.5 kg/m2 at 1 year.

Complete remission of type 2 diabetes mellitus was achieved in 25.0% of patients, and partial remission was achieved in 23.8%.
The complete remission rate was significantly lower than the 49.5% found in patients with BMI 30-35 and 79.0% of patients with BMI  more than  35 kg/m2.

In univariate analysis, non-obese patients who had type 2 diabetes mellitus remission after surgery were heavier and had a wider waist, higher C-peptide levels, shorter disease duration, more weight loss, and higher ABCD score than those without remission.

The ABCD score remained the only independent predictor of success after multivariate logistical regression analyses ( P = 0.003 ).

In conclusion, metabolic surgery may be useful in achieving glycemic control of selected non-obese patients with type 2 diabetes mellitus.
The ABCD score is a simple multidimensional grading system that can predict the success of type 2 diabetes treatment. ( Xagena )

Lee WJ et al, Obes Surg 2015; Epub ahead of print

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