Background

The duodenal switch (DS) is an effective bariatric procedure for managing type 2 diabetes (T2D) in patients with obesity. Despite established preoperative predictors of T2D remission, the relationship between postoperative weight loss and T2D outcomes remains inadequately understood. This study aimed to investigate the correlation between postoperative weight loss and the remission of T2D following DS.

Methods

A retrospective chart review was conducted across two centers for patients undergoing biliopancreatic diversion with DS (BPD-DS) or single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) between 2008-2023. Data mainly encompassed patient demographics, weight-loss outcomes, and T2D remission. A multivariate logistic regression was performed to identify predictors of T2D remission. Subsequently, the cohort was stratified into quartiles based on percent total weight loss (%TWL) to facilitate comparisons of T2D remission rates.

Results

A total of 457 patients (61.5% BPD-DS 38.5% SADI-S; age 45.5+-10.0 years, BMI 54.3+- 8.4 kg/m2) with a follow-up of 1.9+-2.4 years were included. Overall T2D remission rate was 79.8% in our cohort, without any procedural differences (BPD-DS 79.4% SADI-S 81.3%; p=0.74). Statistical analysis revealed that a higher %TWL was a significant predictor of increased T2D remission rates, even after adjusting for variables such as age, sex, and BMI (p=0.001). Remission rates exhibited a proportional increase across %TWL quartiles [Q1: 66.2%, Q2: 83.9%, Q3: 87.0%, Q4: 88.9%] (p=0.004).

Conclusions

Higher %TWL emerged as a significant predictor of increased T2D remission, demonstrating a proportional increase across quartiles. Further research is warranted to explore the long-term effects and potential patient-specific factors influencing these outcomes.