The remission rate, metabolic changes, and quality of life assessment among patients with type 2 diabetes post-bariatric surgery in Riyadh, Saudi Arabia: A cross-sectional study

Lina I. Alnajjar; Mohammed A. Alzaben; Atheer A. Alghamdi; Munirah.O. Alomani; Maha S. Abbas; Rahaf F. Altammami; Sara A. Alabdullatif; Aljawharah K. Bin Rokan; Amira M. Youssef; Alaa A. Alhubaishi

doi:10.15537/smj.2023.44.7.20230080

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Figure 1
- Remission rate of the studied cohort according to American Diabetes Association criteria and International Diabetes Federation criteria.

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Table 1

- Baseline characteristics for the studied cohort according to gender and type of surgery.

Variables	Total (232)	Gender		P-value^*	Surgery		P-value^†
Variables	Total (232)	Male (44%)	Female (56%)	P-value^*	LSG sleeve (93.4%)	RYGB bypass (6.6%)	P-value^†
Age (years), n (%)
mean (± standard deviation [SD])	44.3 ± 10.3	42.8 ± 10.5	45.5 ± 9.9	0.045	43.8 ± 10.1	52.1 ± 12.0	0.002
< 34 years,	38(16.4)	24 (23.5)	14 (10.8)	0.054	37 (17.5)	1 (6.7)	0.002
34- 44 years	93(40.1)	40 (39.2)	53 (40.8)		87 (41.0)	2 (13.3)
45- 54 years	59(25.4)	21 (20.6)	38 (29.2)		54(25.5)	4 (26.7)
>54 years	42(18.1)	17 (16.7)	25 (19.2)		34 (16.0)	8 (53.3)
Education level, n (%)
Post graduate	10 (4.58)	6 (6.31)	4 (3.25)	0.000	6 (3.0)	4 (22.22)	0.379
University	84 (38.53)	51 (53.68)	33 (26.82)		80 (40.0)	4 (22.22)
High school	72 (33.02)	30 (31.57)	42 (34.14)		66 (33.0)	6 (33.33)
<High school	38 (17.43)	8 (8.42)	30 (24.39)		36 (18.0)	2 (11.11)
Illiterate	14 (6.42)	0 (0.0)	14 (11.38)		12 (6.0)	2 (11.11)
Income (Saudi Riyals), n (%)
<5,000 SR, --	31(14.2)	9 (9.5)	22 (17.9)	0.004	30 (15.0)	1 (7.1)	0.513
5,000-10,000 SR	86(39.4)	30 (31.6)	56 (45.5)		80 (40.0)	6 (42.9)
>10,000 SR	101(46.3)	56 (58.9)	45 (36.6)		90 (45.0)	7 (50.0)
Smoking status, n (%)
Current	28 (12.8)	24 (25.0)	4 (3.3)	0.000	27 (13.4)	0 (0.0)	0.051
Ex-smoker	21 (9.6)	20 (20.8)	1 (0.8)		21 (10.4)	0 (0.0)
None	170 (77.6)	52 (54.2)	118 (95.9)		153 (76.1)	14 (100)
Physical activity, n (%)
≥150 min/week	99 (45.4)	50 (50.5)	49 (49.5)	0.172	93 (95.9)	4 (4.1)	0.193
Body mass index, n (%)
mean (± SD)	45±6.75	44.90±6.70	45.51 ± 6.82	0.495	45.31 ± 6.70	44.4 ± 7.65	0.616
< 35 kg/m2	7 (3.0)	4 (3.9)	3 (2.3)	0.000	6 (2.8)	1 (6.7)	0.615
36-40 kg/m2	42 (18.2)	16 (15.7)	26 (20.2)		35 (16.6)	5 (33.3)
> 40 kg/m2	182 (78.8)	82 (80.4)	100 (77.5)		170 (80.6)	9 (60.0)
Diabetes mellitus duration
mean (± SD)	8 ± 7	8 ± 8	9 ± 7	0.501	8 ± 7	15 ± 11	0.001
<5 years	99 (48.1)	50 (55.9)	49 (42.2)	0.307	93 (49.5)	4 (28.6)	0.024
6 -10 years	53 (25.7)	20 (22.2)	33 (28.4)		50 (26.6)	2 (14.3)
>10 years	54 (26.2)	20 (22.2)	34 (29.3)		45 (23.9)	8 (57.1)
Diabetes mellitus complication
Neuropathy	50 (49.01)	20 (51.28)	30 (47.61)	0.326	46 (51.11)	4 (36.36)	0.46
Retinopathy	47 (46.07)	17 (43.58)	30 (47.61)	0.267	40 (44.44)	6 (54.54)	0.068
Vasculopathy	3 (2.94)	1 (2.56)	2 (3.17)	0.603	3 (3.33)	0 (0.0)	0.807
Nephropathy	2 (1.96)	1 (2.56)	1 (1.58)	0.852	1 (1.11)	1 (9.09)	0.826
Comorbidity
Hypertension	111 (48.3)	50 (45.0)	61 (55.0)	0.459	100 (90.1)	11 (9.9)	0.046
Hyperlipidemia	104 (45.2)	42 (40.4)	62 (59.6)	0.152	89 (87.3)	13 (12.7)	0.001
Hyperthyroidism	34 (15.0)	9 (26.5)	25 (73.5)	0.005	30 (88.2)	4 (11.8)	0.93
Metabolic markers
Hemoglobin A1c (%)	8.04 ± 1.59	8.42 ± 1.77	8.22 ± 1.67	0.100	8.93 ± 2.04	8.04 ± 1.59	0.121
Fasting blood sugar (mmol/L)	8.25 ± 1.70	8.99 ± 3.67	9.01 ± 3.32	0.962	9.08 ± 3.44	8.47 ± 3.95	0.528
High density lipoprotein (mmol/L)	9.00 ± 3.46	1.27 ± 0.77	1.23 ± 0.40	0.660	1.23 ± 0.52	1.42 ± 0.86	0.228
Low density lipoprotein (mmol/L)	1.24 ± 0.56	2.54 ± 0.76	2.83 ± 0.97	0.064	2.76 ± 0.90	2.42 ± 0.85	0.157
Ttriglycerides (mmol/L)	2.73 ± 0.91	1.68 ± 0.91	1.62 ± 0.90	0.686	1.63 ± 0.93	1.68 ± 0.61	0.850
Total cholesterol (mmol/L)	1.64 ± 0.90	4.04 ± 1.19	4.56 ± 1.28	0.016	4.37 ± 1.29	4.28 ± 1.08	0.784
Renal functions
Serum creatinine,(µmol/L)	4.36 ± 1.27	71.46 ± 21.74	59.14 ± 26.68	0.00	64.25 ± 26.13	65.36 ± 14.65	0.875
Blood urea nitrogen, (mg/dl)	64.39 ± 25.38	5.73 ± 3.82	4.96 ± 5.28	0.348	5.37 ± 5.00	3.96 ± 1.35	0.316
Thyroid functions
Thyroid stimulating hormone (mIU/L)	5.25 ± 4.78	2.44 ± 1.75	2.58 ± 1.65	0.610	2.46 ± 1.61	2.97 ± 2.55	0.366
Free thyroxin t4 test (pmol/L)	2.52 ± 1.69	12.62 ± 5.73	14.41 ± 4.71	0.063	14.06 ± 5.01	14.49 ± 2.11	0.780

LSG: laparoscopic sleeve gastrectomy, RYGB: Roux-en-y gastric bypass.
↵* P-value comparing males to females,
↵† P-value comparing LSG to RYGB surgery

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Table 2

- Summary of preoperative and postoperative data of the studied cohort.

Variables	Normal values	Before surgery			After surgery
		Total	LSG	RYGB	Total	P-value*	LSG sleeve	P-value^§	RYGB bypass	P-value^†
		Mean±SD	Mean±SD	Mean±SD	Mean±SD	P-value*	Mean±SD	P-value^§	Mean±SD	P-value^†
Weight		121.04±21.49	121±21.07	119.46±33.20	76.55±14.43	0.362	100.87±31.46	0.000	80.11±16.04	0.000^§
BMI	18.50 - 24.90	45.24±6.76	44.74±5.26	44.41±7.65		-	33.51±17.08	0.000	20.10±15.05	0.000
Percentage of total weight loss		-	-	-	17.4±18.59	-	16.73±18.73	-	27.42±13.34	-
HbA1c (%)	4.00 - 5.60	8.25±1.70	8.26±1.67	8.92±2.03	5.94±1.11	0.000	5.90±1.12	0.000	6.21±1.02	0.000
FBS (mmol/L)	<5.60 mmol/L	9.00±3.46	9.06±3.41	8.06±3.80	5.24±1.14	0.013	5.17±0.95	0.000	5.99±2.39	0.002
HDL (mmol/L)	Female >1.30 Male >1.00	1.24±0.56	1.19±0.46	1.28±0.70	1.37±0.63	0.638	1.39±0.66	0.001	1.30±0.29	0.912
LDL (mmol/L)	<2.60	2.73±0.91	2.77±0.88	2.49±0.81	2.78±0.81	0.633	2.78±0.81	0.795	2.69±0.77	0.795
TG (mmol/L)	<1.70	1.64±0.90	1.68±0.94	1.71±0.61	1.28±0.72	0.817	1.28±0.75	0.000	1.23±0.40	0.003
TC (mmol/L)	<5.18	4.36±1.27	4.38±1.29	4.45±0.86	4.34±1.12	0.959	4.33±1.16	0.566	4.36±0.75	0.566
Creatinine (µmol/L)	Female 52.20-91.90 Male 65.40-119.30	64.39±25.38	62.42±20.81	61.33±9.83	61.47±17.50	0.713	61.34±18.08	0.243	63.25±12.51	0.357
BUN (mg/dl)	7–20	5.25±4.78	5.48±5.17	3.67±1.13	4.49±2.35	0.181	4.56±2.40	0.026	3.53±1.43	0.026
TSH (mIU/L)	0.38–5.33	2.52±1.69	2.26±1.60	2.96±254	2.35±2.92	0.694	2.36±3.14	0.785	2.70±1.86	0.783
Free T4 (pmol/L)	7.86–14.41	13.78±5.14	13.93±5.08	14.49±1.95	13.86±4.44	0.404	13.56±4.72	0.239	14.85±1.95	0.239
ADA criteria
Partial					18.9%	-	19.8%	-	26.7%	-
Complete					48.5%	-	50%	-	6.7%	-
No remission					32.6%	-	30.2%	-	66.6%	-
IDF
Optimization					9.7%	-	9.9%	-	6.7%	-
Improvement					5.7%	-	4.7%	-	20.0%	-

ADA: America Diabetes Association, BMI: body mass index, BUN: blood urea nitrogen, DM: diabetes mellitus, FBS: fasting blood sugar, HDL: high density lipoprotein, IDF: international diabetes federation, LDL: low density lipoprotein, LSG: laparoscopic sleeve gastrectomy, RYGB: Roux-en-y gastric bypass, Scr: serum creatinine, SR: Saudi Riyals, T4: thyroxin t4 test, TC: total cholesterol, TG: triglycerides, TSH: thyroid stimulating hormone.
↵* P-value for total before and after surgery
↵^§ P-value comparing the date before and after sleeve surgery
↵^† P-value comparing data before and after bypass surgery
SD: standard deviation

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Table 3

- Mean domain scores according to demographic data and remission status among patients with type 2 diabetes who underwent bariatric surgery.

Variables	Physical domain mean ± SD	Psychological domain mean ± SD	Social domain mean ± SD	Environmental domain mean ± SD
Total	78.05 ± 17.25	63.10 ± 13.81	72.55 ± 22.48	79.48 ± 15.89
Age
< 34 years	81.56 ± 13.64	64.0 ± 11.48	62.32 ± 20.91	77.18 ± 13.9
34–44 years	81.06 ± 16.60	62.92 ± 14.19	75.70 ± 23.0	97.80 ± 15.19
P-value^*	0.869	0.677	0.0022	<0.0001
45–54 years	73.34 ± 18.4	63.53 ± 14.84	74.71 ± 20.65	80.42 ± 16.64
P-value^*	0.020	0.868	0.0045	0.321
>54 years	74.66 ± 18.45	62.02 ± 14.06	72.76 ± 23.13	79.71 ± 18.27
P-value^*	0.063	0.495	0.035	0.491
Gender
Male	83.30 ± 14.15	66.17 ± 12.17	76.52 ± 21.16	81.32 ± 16.50
Female	74.17 ± 18.23	60.88 ± 14.46	69.55 ± 23.06	78.28 ± 15.21
P-value^†	<0.0001	<0.003	0.018	0.146
Educational level
Post graduate	87.77 ± 10.75	70.88 ± 8.16	92.85 ± 10.52	82.77 ± 14.48
P-value^‡	0.005	0.037	0.005	0.1302
University	82.77 ± 15.01	66.05 ± 12.29	74.31 ± 21.20	83.15 ± 14.01
P-value^‡	0.000	0.017	0.450	0.027
High school	79.50 ± 15.77	64.65 ± 11.58	74.26 ± 20.28	97.75 ± 14.71
P-value^‡	0.011	0.039	0.444	<0.0001
<High school	67.07 ± 18.08	54.68 ± 15.29	63.00 ± 26.33	72.68 ± 20.40
P-value^***	0.990	0.694	0.406	0.784
Illiterate	67.14 ± 19.25	56.7 ± 18.97	69.64 ± 22.29	74.28 ± 11.95
Type of surgery
Sleeve	78.25 ± 17.14	62.91 ± 13.91	72.12 ± 22.56	79.46 ± 15.98
Bypass	75.21 ± 19.13	65.71 ± 12.55	78.64 ± 21.08	79.71 ± 15.18
P-value^§	0.593	0.449	0.278	0.953
Remission
Partial	77.09 ± 18.57	61.57 ± 17.19	70.66 ± 25.99	77.23 ± 17.24
P-value^**	0.699	0.610	0.368	0.173
Complete	78.17 ± 16.81	63.0 ± 12.36	71.73 ± 21.47	79.01 ± 16.11
P-value^**	0.915	0.960	0.352	0.306
No remission	78.45 ± 17.25	63.10 ± 13.81	74.84 ± 21.73	81.48 ± 14.70

SD: standard deviation
↵* P-value: compared to the age of <34 years
↵^† P-value: compared to males
↵^‡ P-value: compared to illiterate
↵^§ P-value: compared to bypass surgery
↵** P-value: compared to no remission