and very rapid improvement in glucose levels is often achieved early after surgery, before significant weight loss.using a glycaemic threshold of <6% were 29% with RYGB and 23% with sleeve gastrectomy, versus 5% remission in controls.
Although the anatomical changes achieved with surgery are permanent, and ongoing weight loss and maintenance contribute to improved diabetes control or remission, relapse can still occur.The Swedish Obese Subjects Study reported 10-year remission rates of 36% with RYGB, down from 72% at 2 years after surgery.Bariatric and metabolic surgery are unlikely to be scalable to deliver significant levels of remission.
TDR=total diet replacement; ADA=American Diabetes Association; STAMPEDE=Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently; RYGB=Roux-en-Y gastric bypass1c, whether to induce remission or improve glycaemic control, may result in worsening of microvascular complications, including diabetic retinopathy.reduction in people with retinal changes beyond microaneurysms .
In addition, it is important to run a search for the two ‘diabetes resolved’ codes to check that these have not been used historically, which may result in people being erroneously removed from the diabetes register and no longer considered for reviews. There may also be some overlap in coding, with some people having both a remission and a resolved code. When removing the resolved codes, take care to leave an appropriate audit trail, so that it is clear when and why this has been removed.
Discuss how to amend coding when someone previously in remission relapses again with your computer system user group and local colleagues. It is important to agree whether the person should be coded as having new type 2 diabetes, but practices are likely to want to ensure that the original diagnosis date is still clear. There is no guidance on this in the consensus report.
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