Severe insulin-resistant diabetes (SIRD), is characterized by significant hyperinsulinemia, and presents an increased risk of diabetic nephropathy. A retrospective study recently published in ‘Lancet Diabetes and Endocrinology’ revealed that patients in the SIRD subgroup had better outcomes after metabolic surgery, both in terms of type 2 diabetes remission and renal function, with no additional surgical risk.

489 participants underwent Roux-en-Y gastric bypass or sleeve gastrectomy. The study outcomes were type 2 diabetes remission and improvement of estimated glomerular filtration rate (eGFR).

At 1 year, type 2 diabetes remission was reported in 26 (81%) of 32 and nine (90%) of ten patients with SIRD, 167 (55%) of 306 and 42 (51%) of 83 patients with MOD, and two (13%) of 16 and nine (36%) of 25 patients with SIDD. The mean eGFR was lower in patients with SIRD at baseline and increased postoperatively in these patients in cohorts. In multivariable analysis, SIRD was associated with more frequent type 2 diabetes remission (odds ratio 4·3, 95% CI 1·8–11·2; p=0·0015), and an increase in eGFR (mean effect size 13·1 ml/min per 1·73 m² , 95% CI 3·6–22·7; p=0·0070).

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