Metabolic Surgery for Treatment of Type 2 Diabetes Mellitus: Eligibility, Diabetes Remission Score and Awareness in a Kenyan Tertiary Hospital

Abstract

Metabolic surgery refers to a set of gastrointestinal operations performed on the stomach and intestines with the intent to treat diabetes mellitus and metabolic dysfunctions. Studies have shown significant remission of type 2 diabetes mellitus (T2DM) after metabolic surgery and a reduction in comorbidities and associated mortality. Different eligibility criteria have been adopted to determine qualification for surgery. Preoperatively, the diabetes remission score has been devised and validated to assess the likelihood of remission of T2DM with surgery. The procedures shown to have significant outcomes towards the treatment of T2DM include adjustable band gastrectomy and sleeve gastrectomy among many others. STUDY OBJECTIVE The objective of the study was to assess the eligibility of T2DM patients for metabolic surgery, to determine the diabetes remission score and to assess awareness of metabolic surgery for treatment of T2DM at Kenyatta National Hospital (KNH) diabetes/ endocrinology clinic. STUDY DESIGN AND METHODOLOGY This was a cross-sectional study at the KNH diabetes/endocrinology outpatient clinic on patients with T2DM being followed up at the clinic who met the inclusion criteria and gave informed consent. Newly diagnosed patients were excluded. Two hundred and nineteen participants were selected using the convenience sampling method and data collection proceeded for a duration of one month from September 2021 to October 2021. A structured data collection sheet was used to collect data which was then entered into data sheets and analysed via IBM Statistics SPSS version 23.0. The participants’ heights (m), weights (kg) were taken and the body mass index (kg/m2) calculated for each patient. Additional data collected included the participants’ age, HBA1c levels, presence of any chronic illnesses, the xii medication that the participants were on, and responses to a question on awareness of treatment options available for T2DM. RESULTS A total of 219 conveniently selected patients in the Diabetes/ Endocrinology department at Kenyatta National Hospital were selected and included in the study. Demographic, clinical, and laboratory data, height, weight, BMI, medication use, and response on awareness of different treatment options for T2DM was entered in the data collection sheet. Frequency, means, standard deviation and median were used to describe the data. The level of significance was set at <0.05. Continuous variables analysed using Mann Whitney U test and categorical variables analysed using Pearson’s correlation index. From the study, the average age of participants was 58.98±12.05 years, with age range from 24 to 96 years. Majority of the participants were female (69.4%, n=219). From the study, eligibility for metabolic surgery stood at 10.05% (DSS II). Among the eligible persons, two participants had a DiaRem score of 3-7, two had a DiaRem score of 8-12, four had a DiaRem score of 13-17 while fourteen had a DiaRem score of 18-22. Of those who were eligible, only 36.36% were aware of metabolic surgery as a treatment option for T2DM. There was a statistically significant relationship between body mass index and eligibility for surgery (p=0.000, n=219), but no relationship between age and metabolic surgery (p=0.386, n=219). There was a positive relationship between grade of obesity (p=0.000) as well as awareness of metabolic surgery (p=0.047) and eligibility for metabolic surgery. CONCLUSION In Kenyatta National hospital, there is a considerable proportion of patients with T2DM who are eligible for metabolic surgery, with acceptable Diabetes Remission scores. A small proportion of those eligible for metabolic surgery are aware of metabolic surgery as a treatment option for T2DM. xiii SIGNIFICANCE OF THE STUDY The study has yielded information on qualification for metabolic surgery, preoperative probability of T2DM remission after metabolic surgery and patients’ awareness of metabolic surgery as a treatment for T2DM.