Long-Term Remission Rate of Type 2 Diabetes Following Bariatric Surgery: A Retrospective Cohort Study in Adult Patients in Riyadh, Saudi Arabia.

Abstract

Introduction Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder that poses significant health and economic burdens, particularly in regions like Saudi Arabia where prevalence rates are among the highest globally. Bariatric surgery has emerged as a promising intervention, not only for weight reduction but also for inducing diabetes remission. However, while the short-term benefits of the procedure are well documented, long-term outcomes remain under-explored, especially in Saudi populations. This study aims to evaluate the long-term remission rates of T2DM and weight measurements following bariatric surgery in adult Saudi patients in Riyadh. Methods Using a retrospective cohort design, this study analyzes medical records of patients aged 18-65 who underwent bariatric surgery in the period of 2016-2020 and assesses Hemoglobin A1c (HbA1c) levels pre and post-surgery and diabetes remission using American Diabetes Association (ADA) criteria. The research also investigates factors influencing relapse rates and potential gender differences in remission outcomes. Results Out of 74 participants, the majority were females (53, 71.62%) compared to males (21, 28.37%). The mean BMI was recorded at 44.91 ± 6.68 kg/m², indicating that participants generally fell within the obesity weight range. The mean HbA1c level prior to surgery was 8.70 ± 1.68, indicating suboptimal glycemic control at baseline. The mean HbA1c level decreased from 8.70 ± 1.68 before surgery to 6.76 ± 1.42 at the 12-month mark. The results indicated significant improvements in glycemic control post-surgery, as evidenced by the marked reduction in HbA1c levels at various time points (1 year, 2 years, etc.) with a p-value of 0.000. In terms of remission, the data showed a distinct result: out of 74 participants, only 20 participants (27%) achieved diabetes remission. Furthermore, seven participants (35%) out of the diabetic remission group experienced a relapse post-intervention and one participant achieved a second diabetes remission. In the assessment of risk factors for relapse, baseline BMI and gender were not strong factors in determining whether a patient experiences diabetes relapse post-surgery. As for weight measurements, the findings showed a steady increase in both Percent Excess Weight Loss (%EWL) and Percent Total Weight Loss (%TWL) in the initial years following surgery with no significant variations across the years, and the p-values were 0.710 and 0.446, respectively. For Percent Weight Regain (%WR), there was a significant and steady increase across the period, with values starting at 6.77 ± 11.8% at Year 2, increasing over the years, and peaking again at 26.64 ± 44.84% by Year 5, with a p-value of < 0.001. Conclusion This study is consistent with previous studies and provides compelling evidence that bariatric surgery leads to substantial improvements in glycemic control and weight reduction among Saudi patients with T2DM. However, it shows a lower percentage of remission in our participants compared to other local and global studies. Further local research is recommended to confirm our findings, analyze the reason for lower rates, and investigate the predictors of remission and relapse. This study fills a crucial gap in localized data, providing insights that could guide future healthcare strategies and improve the management of T2DM in the region.