Efficacy of bariatric surgery in improving metabolic outcomes in patients with diabetes. A 24-month follow-up study from a single center in the UAE

Hanadi Alnageeb,1 Elamin Abdelgadir,2 Azza Khalifa,2 Mohamed Suliman,3 Subash Chander Gautam,4 Laurent Layani,4 Sriganesh Subramaniam,4 Alaaeldin Bashier2 1Medical Department, Fujairah Hospital, Fujairah, UAE; 2Endocrine Department, Dubai Hospital, Dubai Health Authority, Dubai, UAE; 3Endocrinology, Imperial College London Diabetes Centre, Al Ain, UAE; 4Surgical Department, Fujairah Hospital, Fujairah, UAE Background: Owing to its impact on weight loss, remission of diabetes mellitus and metabolic syndrome, bariatric surgery has offered hope for grossly obese individuals. In recent years, obesity has increased in the UAE and the use of bariatric surgery has increased in-line with this trend. However, data regarding bariatric surgery outcomes in diabetic Emirati people is scarce. Objective: To evaluate the effect of bariatric surgery in patients with diabetes mellitus. Methods: This is a retrospective analysis of diabetic patients treated with bariatric surgery with a minimal follow-up of 1 year and extended for some patients (21) to 2 years follow up. A total of 80 patients underwent bariatric surgery. Two surgical procedures were used; laparoscopic sleeve gastrectomy (n=53) or mini-gastric bypass between January 1, 2015, and July 20, 2017. Results: Mean baseline weight was 119.2±31.2 kg, this has significantly dropped to 100.1±23.1, 91.2±22.3, 82.3±17.5, and 81.3±15.3 kg at 3, 6, 12, and 24 months respectively, and this change was statistically significant P<0.001 at each time point. Mean baseline HbA1c was 8.6% ± 2.3% and this dropped significantly to 6.5±1.7, 5.9±1.2, 5.6±0.8, and 5.4±0.7 at 3, 6, 12, and 24 months respectively (P<0.000). In 49 (61.3%) we considered fatty liver based on ultrasound features either with or without elevation in alanine aminotransferase (ALT). We noticed a significant decrease in ALT at 3, 6, and 12 months after surgery. Furthermore, 11 patients (22.4%) showed sonographic features of improvement in fatty liver in addition to normalization of ALT. Conclusions: Bariatric surgery was effective over a follow-up period of 2 years in achieving significant weight loss as well as resulting in improvements in glycemic control, blood pressure, and fatty liver. Keywords: sleeve gastrectomy, type 2 diabetes, type 1 diabetes, excess weight loss, HbA1c, weight, bariatric surgery, Middle East, UA