The Remission of Type 2 Diabetes Mellitus in Chinese Patients After Metabolic Surgery and Its Preoperative Contributing Factors: A Cohort Study

Abstract Background and Objective: Existing data about the contributing factors of operative effect for type 2 diabetes mellitus (T2DM) are still limited in Chinese patients, especially about preoperative blood routine and biochemical indexes. We evaluated a prospective cohort of T2DM patients in early and middle stage with obesity to assess the post-operative prognosis and investigate its contributing factors.Methods: Adult T2DM participants in early and middle stage with obesity were enrolled and received metabolic surgery. Clinical data such as age, sex, baseline body mass index, percentage excess weight loss, glycemia range and drug consumption were collected and analyzed. Patients were managed by a multi-disciplinary team and followed up for 12 months. Complete remission was defined as HbA1c < 6.0%, fasting glucose < 5.6 mmol/l, without pharmacological intervention for at least 3 months. Results: In this study, a total of 96 T2DM patients with metabolic surgery were included. Among them, 61 (63.54%) patients had complete remission and 85 (88.50%) had post-operative partial remission after a 12-month clinical follow-up. Only 1 patient was reported to have an anastomotic leak; no surgical mortality during the follow-up. According to the complete remission or not, the patients were divided into two groups. There were significant differences on stroke history, fasting blood sugar and white blood cell between them. Furthermore, in multivariable analyses models, preoperative triglyceride (adjusted OR, 0.585; 95%CI, 0.418-0.819; p<0.01) and preoperative lymphocyte count (adjusted OR, 2.647; 95%CI, 1.141-6.142; p < 0.05) was significantly associated with complete remission of T2DM.Conclusion: Our data suggest that T2DM patients with lower triglyceride and higher lymphocyte count tended to achieve post-operative remission. Preoperative evaluation of lipid metabolism and immune function may be helpful for the evaluation of prognosis of metabolic surgery.