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Background characteristics and diabetes remission after laparoscopic sleeve gastrectomy in Japanese patients with type 2 diabetes stratified by BMI: subgroup analysis of J-SMART

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Abstract

Aim

The J-SMART study was the first national survey of Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We performed a subgroup analysis of J-SMART focusing on the differences in patient background and diabetes remission between patients with BMI 32–34.9 kg/m2 and those with higher BMI.

Methods

In this multi-institutional retrospective study at 10 certified bariatric institutions, 203 Japanese with type 2 diabetes (T2D) and BMI of 32 kg/m2 or higher were analyzed (mean age: 49.2 years, BMI: 43.8 kg/m2, HbA1c: 7.6%). Patients were stratified into five groups according to preoperative BMI.

Results

Background characteristics in BMI 32.0–34.9 group were higher adjusted HbA1c, higher visceral/subcutaneous fat area ratio, higher prevalence of diabetic retinopathy, higher frequency of insulin use and lower serum C-peptide. Although 2-year percent total weight loss (21.7%) and diabetes complete remission (CR) rate (52.4%) were lower in BMI 32.0–34.9 group, diabetes improvement rate was 81.0%, and the decrease in HbA1c and number of antidiabetic drugs were comparable or greater than those with higher BMI. Higher BMI and no insulin use were significant independent predictors of diabetes CR. No significant independent predictor was identified for diabetes improvement.

Conclusion

The patients with 32–34.9 kg/m2 were characterized by more severe visceral obesity, T2D and the complications, and lower intrinsic insulin secretion capacity. LSG should be considered as a treatment option for patients with BMI 32–34.9 kg/m2, to improve diabetes control.

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Acknowledgements

The authors wish to thank Aki Hagiwara for the collection and assembly of data.

Funding

J-SMART was supported by a grant for research on intractable diseases from the Ministry of Health, Labour and Welfare of Japan (H28-nanji-ippan-014).

Author information

Authors and Affiliations

  1. Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura-City, Chiba, 285-8741, Japan

    Atsuhito Saiki, Takashi Yamaguchi, Daiji Nagayama & Ichiro Tatsuno

  2. Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan

    Akira Sasaki

  3. Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan

    Takeshi Naitoh

  4. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Hisahiro Matsubara

  5. Department of Endocrinology, Haematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan

    Koutaro Yokote

  6. Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan

    Shinichi Okazumi

  7. Department of Medicine, Shiga University of Medical Science, Shiga, Japan

    Satoshi Ugi

  8. Department of Surgery, Kohnan Hospital, Shiga, Japan

    Hiroshi Yamamoto

  9. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan

    Masayuki Ohta

  10. Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Iwate, Japan

    Yasushi Ishigaki

  11. Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan

    Kazunori Kasama & Yosuke Seki

  12. Department of Endocrinology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Motoyoshi Tsujino

  13. Department of Internal Medicine, Mihama Hospital, Chiba, Japan

    Kohji Shirai

  14. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Yasuhiro Miyazaki

  15. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan

    Takayuki Masaki

  16. Nagayama Clinic, Tochigi, Japan

    Daiji Nagayama

Authors
  1. Atsuhito Saiki
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Corresponding author

Correspondence to Atsuhito Saiki.

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Conflict of interest

Dr. Naitoh received honorarium from Johnson & Johnson, Inc., Medtronic, Inc. and received research funding from Japan Society for the Promotion of Science, Grant-in-Aid for Scientific Research (C) (#17K10575). Dr. Ishigaki received honorarium from MSD Ltd., Sanofi Ltd., Bayer Yakuhin Ltd., Takeda pharmaceutical Co Ltd., Novo Nordisk Pharma Ltd., Novartis Pharma Ltd., Ono pharmaceutical company, Kowa pharmaceutical Co Ltd., and received donation from Ono pharmaceutical company and MSD Ltd. Dr. Yokote received honorarium from Kowa Company, Ltd., MSD K.K., Astellas Pharma Inc., Mitsubishi Tanabe Pharma Corporation, Amgen K.K., Takeda Pharmaceutical Company Limited, Sanofi K.K., Ono Pharmaceutical Co., Ltd., AstraZeneca K.K., Daiichi Sankyo Company, Limited, Novartis Pharma K.K., Sumitomo Dainippon Pharma Co., Ltd., Kyowa Kirin Co., Ltd., Pfizer Japan Inc., Novo Nordisk Pharma Ltd., Nippon Boehringer Ingelheim Co., Ltd., Eli Lilly Japan K.K., Taisho Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., received research funding from Taisho Pharmaceutical Co., and received donations from Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited, MSD K.K., Pfizer Japan Inc., Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd., Kao Corporation, Ono Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Sumitomo Dainippon Pharma Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Daiichi Sankyo Company, Limited, Teijin Pharma Limited, Shionogi Co., Ltd., Astellas Pharma Inc., Kowa Company, Ltd., Bayer Yakuhin, Ltd. Dr. Kasama received honorarium from Johnson & Johnson, Inc., Medtronic, Inc. and received research funding from Medtronic, Inc. The remaining authors have nothing to disclose.

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Saiki, A., Yamaguchi, T., Sasaki, A. et al. Background characteristics and diabetes remission after laparoscopic sleeve gastrectomy in Japanese patients with type 2 diabetes stratified by BMI: subgroup analysis of J-SMART. Diabetol Int 12, 303–312 (2021). https://doi.org/10.1007/s13340-020-00487-x

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  • DOI: https://doi.org/10.1007/s13340-020-00487-x

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