Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study

Abstract

Aims/hypothesis The aim of this study was to examine the effect of Roux-en-Y gastric bypass (RYGB) surgery on diabetes remission, subsequent diabetes relapse and micro-and macrovascular complications in individuals with type 2 diabetes and obesity (BMI >35 kg/m 2 ) in a real-world setting. Methods This was a population-based cohort study of 1111 individuals with type 2 diabetes treated by RYGB at hospitals in Northern Denmark (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015), and 1074 matched non-operated individuals with type 2 diabetes. Diabetes remission was defined as no glucose-lowering drug use with HbA 1c <48 mmol/mol (<6.5%), or metformin monotherapy with HbA 1c <42 mmol/mol (<6.0%). Data on complications were ascertained from medical registries with complete follow-up.Results At 1 year of follow-up, 74% of the cohort treated by RYGB experienced diabetes remission, while 27% had relapsed after 5 years. Predictors of non-remission were age >50 years, diabetes duration >5 years, use of glucose-lowering drugs other than metformin, and baseline HbA 1c >53 mmol/mol (>7.0%). Compared with the non-operated cohort using adjusted Cox regression (5.3 years follow-up), the cohort treated by RYGB had 47% lower risk of microvascular complications (HR 0.53 [95% CI 0.38, 0.73]) and a statistically non-significant 24% lower risk of macrovascular complications (HR 0.76 [95% CI 0.49, 1.18]). Diabetes remission vs non-remission at 1 year was associated with reduced HR of 0.43 (95% CI 0.25, 0.72) for microvascular complications and with HR of 0.76 (95% CI 0.40, 1.45) for macrovascular complications. Conclusions/interpretation In routine clinical care, three out of four individuals with type 2 diabetes and obesity treated by RYGB experienced diabetes remission after 1 year, whereas 27% of these individuals had relapsed at 5 years follow-up. RYGB was associated with substantially decreased risk of microvascular complications and non-significantly fewer macrovascular complications, with early diabetes remission as a clear predictor of reduced microvascular complications.

New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range”

“…Two population-based cohorts that were matched with no surgical management show results from real world settings in Europe, using stricter diabetes remission criteria [25,26]. A Danish cohort, with 1111 patients with diabetes, found a one-year diabetes remission rate of 74% and a relapse rate of 27% after 5 years of follow-up.…”

“…A Danish cohort, with 1111 patients with diabetes, found a one-year diabetes remission rate of 74% and a relapse rate of 27% after 5 years of follow-up. However, GBP was the only surgical technique included [25]. In another cohort from the United Kingdom, Yska et al found greater remission of diabetes after GBP (n = 280) than after SG (n = 83) or gastric band (n = 200) [26].…”

Family Influences on Patients’ Decisions to Undergo Bariatric Surgery

“…The researchers were unable to identify a reason for these results and suggested that additional research is needed in this area. Bariatric surgery can help successfully remit type 2 diabetes and may help control hypertension with reduced or no medication therapy . Although bariatric surgery can help resolve common comorbidities, some patients do not pursue surgery because of the surgical risks and complications, required lifestyle changes, the cost of surgery, and the time‐consuming process required to prepare for bariatric surgery …”

Regulatory peptides and systems biology: A new era of translational and reverse‐translational neuroendocrinology

“…Along with a rise in obesity, the prevalence of type 2 diabetes (T2D) is rapidly increasing and bariatric surgery has been documented to lead to rapid remission of T2D 17 . However, curing all diabetics by bariatric surgery is impossible: bariatric surgery is life‐changing and so not suitable for many individuals; it is expensive; and it remains risky.…”