Type 2 diabetes remission in gynaecologic oncology patients completing an acute preoperative weight loss protocol: a case series.

Abstract

Background: The objective of this study was to review type 2 diabetes (T2D) remission and glycaemic improvement in gynaecologic oncology patients with class 3 obesity undergoing preoperative weight loss.

Methods: This was a case series of 92 gynaecologic oncology patients with BMI ≥40 kg/m² and T2D who underwent preoperative weight loss with a low-calorie liquid meal replacement. Patients were classified as high or low likelihood of remission based on diabetes duration, glycated haemoglobin (A1C) and insulin use. Data were summarised descriptively and Fisher's exact test and paired t-test were used as inferential statistics using SAS 9.4.

Results: Twenty-one patients with a mean age of 57.8 (SD = 11.7) years completed a weight loss protocol of median 14 (IQR = 10.5-16.5) weeks. Eighteen (86%) had endometrioid endometrial carcinoma or atypical endometrial hyperplasia. Initial mean BMI and A1C were 48.0 (SD = 6.7) kg/m² and 8.2% (SD = 2.3%). After the protocol, mean BMI and A1C were 43.1 (SD = 5.5) kg/m² and 7.1% (SD = 1.7%). On average, A1C decreased 1.1% (95% CI: 0.5-1.6, p < 0.05) after weight loss. 3/21 patients experienced diabetes remission. The rate of remission was 2/6 and 1/15 for patients coded as high and low likelihood of remission (p = 0.18).

Conclusions: Weight, BMI and A1C were significantly reduced by preoperative weight loss in gynaecologic oncology patients with T2D. There was a low rate of diabetes remission, with most patients having clinical characteristics predictive of a low likelihood of remission.