Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery

Abstract

BACKGROUND: Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Rouxen-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. STUDY DESIGN: We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c <6.5%. Relapse was defined as recurrence medication use and/or hemoglobin A1c !6.5%. Independent correlates of T2D remission and relapse were identified using logistic regression. RESULTS: Six hundred and twenty-one patients (aged 46.7 AE 10.6 years; 30% on insulin; BMI 49.8 AE 8.3 kg/m 2) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse. CONCLUSIONS: This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission.

Insulin use and new diabetes after acceptance for bariatric surgery: comparison of outcomes after completion of surgery or withdrawal from the program

“…11 Eighty percent of those with pre-existing T2D who completed surgery had remission, the majority within the first year of surgery, in agreement with previous observations. [1][2][3] The timing of remission parallels the pattern of weight loss which is also greatest within the first year of surgery, 2 6 17 and is in keeping with the positive association that we observed between remission and change in BMI 1 year after surgery. Remission was also associated with a shorter duration of diabetes, a lower mean HbA1c and a lower rate of insulin use at referral.…”

“…A high proportion of people with type 2 diabetes (T2D) who undergo bariatric surgery can have remission of diabetes, or improvement in glycemic control. [1][2][3][4][5][6][7] However, longer term studies have shown that the remission of diabetes is often not sustained. For example, a recent US study found that 35% of those who had remission of diabetes after bariatric surgery had recurrence within 5 years, 1 and recently published data from the Swedish Obese Subjects study showed overall relapse rate of 54% at 10 years.…”

“…8 Risk factors for diabetes relapse after surgery include a longer duration of diabetes, preoperative insulin use, poor preoperative glycemic control, impaired β-cell function, greater preoperative weight and a lesser degree of postoperative weight loss. [1][2][3] However, even if diabetes relapses it often requires less medication 3 9 10 and a recent study…”

Testosterone Therapy for Prevention and Treatment of Obesity in Men

“…125 Although T2DM remission can be as high as 74% at 1 year postsurgery, T2DM relapse increased over time with a longer follow-up duration. 125,126 As summarized earlier, TTh for 8 years results in weight loss corresponding to 16.8% to 23.6%, depending on baseline obesity grade (Table 1). 55 An 11-year a References.…”

Update on technologies, medicines and treatments

“…A study presented at the American College of Surgeons 105 th Annual Clinical Congress examined which people are most likely to see remission of their type 2 diabetes following gastric bypass surgery . The study followed 621 people who underwent a Roux‐en‐Y gastric bypass with a median follow‐up of 4.9 years.…”