P49 Metabolic control in patients with diabetes mellitus and obesity. Antidiabetic treatment vs bariatric surgery

Abstract

Introduction: In type 2 diabetic and obese patients it is frequently difficult to achieve the goals of weight, blood pressure (BP), metabolic and lipid control with lifestyle changes and pharmacotherapy and sometimes accomplished by bariatric surgery (BS).

Objectives: To evaluate the metabolic effects of BS in a population of patients with DM and obesity in comparison with antidiabetics.

Materials and methods: 105 patients with DM were evaluated, 55 underwent antidiabetic treatment (AD) and 50 underwent BS. Anthropometric measurements, body mass index (BMI), BP, hemogram, hepatogram, renal function, glycemia, HbA1c, lipidogram, triglycerides / HDL index (TG / HDL) and bone mineral metabolism were analyzed. Statistical analysis: Student’s and Mann-Whitney-Wilcoxon tests were applied. Spearman correlation coefficient was calculated. Values expressed in average ± standard deviation. Significant p< 0,05.

Results: The age of the group with AD was 58.51 ± 7.59 vs 55.41 ± 8.77 years of the BS group (without significant difference). The duration of diabetes was 8.1 years for both groups. Of the total number of patients with diabetes with AD 22% were treated with insulin and 95% were taking Metformin. 39% received iDPP-4, 100% antihypertensive treatment and 75% statins. Of all the patients with diabetes after surgery only 7% were still treated with insulin and 14% were taking Metformin, 11% iDPP-4, 54% antihypertensive drugs and 31% statins. Patients with DM who underwent BS had lower BMI (p 0.005), systolic BP (p 0.049), diastolic BP (p 0.007), glycemia and HbA1c (<0.0001), triglycerides (p 0.0027), HDL (p0.0039) TG / HDL index (p 0.0009). There were no significant differences in bone mineral metabolism, total cholesterol, LDL, nonHDL, and renal function. When we evaluated the HbA1c ˂7% goals it was achieved in 41.82% of BS versus 17.02% of patients with AD (p 0.006). The 10.91% of non-HDL <100 of the AD differ significantly from the 30.0% in post BS patients: (p 0.01). 65.45% of controls with TG <150 differ significantly from 83.67% in post BS patients: (p 0.034). There were no differences in LDL and blood pressure goals.

Conclusions: we achieved with BS a better BMI, BP and glycemic control. The lipid profile and renal function were controlled in both treatments.