Diabetic medicine : a journal of the British Diabetic Association · 2026
Type 2 diabetes remission following a comprehensive metabolic program including surgery in adults with BMI ≥50 kg/m2 versus BMI <50 kg/m2.
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Zhen Xi May, Macdonald Annette, Woodham Benjamin, Ryan Brendan, Hng Tien-Ming, Azar Eileene, Hanna Marina, Yap Jesmine, Paulose Jeenat, Li Guizhi, Twigg Stephen M, Ahlenstiel Golo, Wong Jencia
Аннотация
AIMS: Previous reports have suggested that higher baseline BMI (bBMI) or %excess weight loss (EWL) are independent predictors of type 2 diabetes mellitus (T2DM) remission after metabolic bariatric surgery (MBS). However, %EWL appears lower in individuals with bBMI ≥50 kg/m2 than those with lower bBMI. Thus, this cohort study aimed to examine T2DM remission after MBS in adults with bBMI <50 kg/m2 versus bBMI ≥50 kg/m2.
METHODS: This cohort study included adults with obesity and T2DM who underwent MBS between 01/06/2018 and 31/05/2024 at an Australian tertiary hospital. The primary outcome was complete diabetes remission (HbA1c < 6.0%) at 12 months following MBS.
RESULTS: At 12 months following MBS, when compared to those with bBMI <50 kg/m2, a higher proportion of patients with bBMI ≥50 kg/m2 experienced complete diabetes remission (37.8% vs. 66.7%, 95% CI for the difference -48.5% to -6.3%, p = 0.014); this was no longer significant after adjustment for variables such as baseline T2DM duration and HbA1c. The bBMI ≥50 kg/m2 group had greater total weight loss (kg) but lower %EWL, though neither was an independent predictor of remission.
CONCLUSIONS: In our cohort, neither bBMI ≥50 kg/m2 nor %EWL appeared as an independent predictor of T2DM remission. The higher proportion with remission (on unadjusted analyses) in those with bBMI ≥50 kg/m2 potentially reflects less advanced diabetes despite greater obesity. Early consideration of MBS may be beneficial given that markers of diabetes duration/severity appeared as potentially important variables associated with T2DM remission.
METHODS: This cohort study included adults with obesity and T2DM who underwent MBS between 01/06/2018 and 31/05/2024 at an Australian tertiary hospital. The primary outcome was complete diabetes remission (HbA1c < 6.0%) at 12 months following MBS.
RESULTS: At 12 months following MBS, when compared to those with bBMI <50 kg/m2, a higher proportion of patients with bBMI ≥50 kg/m2 experienced complete diabetes remission (37.8% vs. 66.7%, 95% CI for the difference -48.5% to -6.3%, p = 0.014); this was no longer significant after adjustment for variables such as baseline T2DM duration and HbA1c. The bBMI ≥50 kg/m2 group had greater total weight loss (kg) but lower %EWL, though neither was an independent predictor of remission.
CONCLUSIONS: In our cohort, neither bBMI ≥50 kg/m2 nor %EWL appeared as an independent predictor of T2DM remission. The higher proportion with remission (on unadjusted analyses) in those with bBMI ≥50 kg/m2 potentially reflects less advanced diabetes despite greater obesity. Early consideration of MBS may be beneficial given that markers of diabetes duration/severity appeared as potentially important variables associated with T2DM remission.