Improved Gastric Bypass Outcomes in Patients With Type 2 Diabetes and Comorbid Liver Steatosis

Bariatric and metabolic surgery outcomes were found to differ among subsets of patients with type 2 diabetes mellitus (T2DM), and those with liver steatosis were more likely to have better long-term glycemic outcomes. These findings, from a retrospective review of medical records, were published in Diabetes Care.

Patients (N=519) with T2DM who underwent primary Roux-en-Y gastric bypass at Cleveland Clinic between 2004 and 2012 were included. Clinical characteristics from a median follow-up time of 8 (interquartile range [IQR], 5-14) years were assessed.

At baseline, most patients were women (67.1%); median age was 52 years and and median body mass index was 45.2.

Following the procedure, nearly half of patients (49.1%) achieved remission of diabetic symptoms.  Patients who experienced remission were more often women (P =.035), younger (P <.001), with greater body mass index (P <.001), had a shorter duration of T2DM (P <.001), used insulin less frequently (P <.001), took fewer antidiabetic medications (P <.001), had lower blood glucose values (P <.001), and had better glycemic control (P <.001).

Most patients (78.4%) had some degree of steatosis (grades 1-3) at the time of the procedure. Lobular inflammation (69.2%) and hepatocyte ballooning (35.5%) were commonly observed. Lobular inflammation (75% vs 46%; P <.001), hepatocyte ballooning (43% vs 6%; P <.001), and fibrosis (47% vs 17%; P <.001) were more common among those with steatosis compared with those without steatosis.

Stratified by nonalcoholic fatty liver disease (NAFLD; steatosis grades 1-3), more patients with NAFLD (52%) achieved remission of T2DM compared with those without comorbid NAFLD (39%; P =.027). Rates of remission increased with grade of steatosis: 39% for grade 0; 50% for grade 1; 55% for grade 2; and 57% for grade 3 (P =.079).

Remission was less likely among patients who had a longer duration of T2DM (odds ratio [OR], 0.87; 95% CI, 0.82-0.92; P <.001), used insulin (OR, 0.33; 95% CI, 0.19-0.56; P <.001), used antidiabetic medications (OR, 0.50; 95% CI, 0.37-0.67; P =.001), or who had poor glycemic control (OR .53; 95% CI, 0.32-0.86; P =.01) prior to the procedure.

The investigators found that the presence of liver steatosis prior to the procedure was associated with diabetic remission (OR, 1.96; 95% CI, 1.04-3.72; P =.038).

This study was limited by including only 1 type of bariatric surgery procedure (Roux-en-Y gastric bypass); it remains unknown whether these results would be generalizable to other procedures.

These findings indicate that patients with T2DM and comorbid liver steatosis were more likely to achieve diabetic remission following RYGM.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Vangoitsenhoven R, Wilson RL, Cherla DV, et al. Presence of liver steatosis is associated with greater diabetes remission after gastric bypass surgery. Diabetes Care. 2020;dc200150. doi:10.2337/dc20-0150