Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study

Purnell, Jonathan Q.; Selzer, Faith; Wahed, Abdus S.; Pender, John R.; Pories, Walter J.; Pomp, Alfons; Dakin, Greg; Mitchell, James E.; Garcı́a, Luis; Staten, Myrlene A.; McCloskey, Carol; Cummings, David E.; Flum, David R.; Courcoulas, Anita P.; Wolfe, Bruce M.

doi:10.2337/dc15-2138

Cited by 119 publications

(84 citation statements)

References 33 publications

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“…These data differ from those reported by Purnell et al (40), which suggest that the significant differences in 3-year rates of diabetes remission between RYGB and LAGB are independent of weight loss and manifest from unique metabolic mechanisms of RYGB. Their findings may be attributed to possible presurgery differences in β-cell function and insulin sensitivity between their groups, key predictors of glucose control after bariatric surgery, which, unfortunately, were not measured in their study (40). …”

Section: Discussioncontrasting

confidence: 99%

Glucose Metabolism After Gastric Banding and Gastric Bypass in Individuals With Type 2 Diabetes: Weight Loss Effect

et al. 2016

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OBJECTIVEThe superior effect of Roux-en-Y gastric bypass (RYGB) on glucose control compared with laparoscopic adjustable gastric banding (LAGB) is confounded by the greater weight loss after RYGB. We therefore examined the effect of these two surgeries on metabolic parameters matched on small and large amounts of weight loss.RESEARCH DESIGN AND METHODSSeverely obese individuals with type 2 diabetes were tested for glucose metabolism, β-cell function, and insulin sensitivity after oral and intravenous glucose stimuli, before and 1 year after RYGB and LAGB, and at 10% and 20% weight loss after each surgery.RESULTSRYGB resulted in greater glucagon-like peptide 1 release and incretin effect, compared with LAGB, at any level of weight loss. RYGB decreased glucose levels (120 min and area under the curve for glucose) more than LAGB at 10% weight loss. However, the improvement in glucose metabolism, the rate of diabetes remission and use of diabetes medications, insulin sensitivity, and β-cell function were similar after the two types of surgery after 20% equivalent weight loss.CONCLUSIONSAlthough RYGB retained its unique effect on incretins, the superiority of the effect of RYGB over that of LAGB on glucose metabolism, which is apparent after 10% weight loss, was attenuated after larger weight loss.

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Section: Discussioncontrasting

confidence: 99%

Glucose Metabolism After Gastric Banding and Gastric Bypass in Individuals With Type 2 Diabetes: Weight Loss Effect

et al. 2016

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“…Conversely, the insurer groups may experience varying levels of social or economic changes following bariatric surgery, which could have important differential implications for mental health outcomes. Finally, moderate increases in diabetes risk over time were observed in both groups, which is expected given that a small proportion of patients who achieve remission after surgery are known to relapse .…”

Section: Discussionmentioning

confidence: 68%

Reduction in Comorbid Conditions Over 5 Years Following Bariatric Surgery in Medicaid and Commercially Insured Patients

Takemoto

Wolfe

Nagel

et al. 2018

Obesity

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Objective. We sought to determine changes in the prevalence of comorbid disease following bariatric surgery in Medicaid patients compared to commercially insured patients. Methods. Data were obtained from the Longitudinal Assessment of Bariatric Surgery, an observational cohort study of adults undergoing bariatric surgery at one of 6 geographically diverse centers in the US. We identified 1201 patients who underwent Roux-en-Y Gastric Bypass with 5 years of follow-up. We used Poisson mixed models to estimate relative risks (RR) and compare changes in common comorbidities between insurance groups within 0–1 and 1–5 years post-surgery. Propensity scores were used to achieve balance in the baseline comorbidity burden between Medicaid and Commercial patients. Results. In the first year, risk of all six comorbidities decreased substantially over time in both groups, ranging from a 32 to 69% decrease from baseline. After 1-year post-surgery, the risk of disease was stable in both groups (RRs ranged from 1.0 to 1.1). After propensity score weighting, the RRs in the first year were more similar in magnitude while the RRs in the 1–5 year period were unchanged. Conclusions. These results suggest that Medicaid patients experience medium-term reduction in comorbid disease after bariatric surgery.

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“…Multiple short-term studies 2,5–8,11,15,18,20–27 have shown significant remission rates, lower incidence rates, or both, of type 2 diabetes after bariatric surgery. Given the value of longer-term follow-up, our U.S. study, the SOS study, and a study with a 10-year follow-up involving 22 patients who underwent biliopancreatic diversion 26 are of interest, since these studies have followed patients for more than 5 years with respect to end points associated with type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Weight and Metabolic Outcomes 12 Years after Gastric Bypass

et al. 2017

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BACKGROUND Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States. METHODS A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (non-surgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia. RESULTS The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was −45.0 kg (95% confidence interval [CI], −47.2 to −42.9; mean percent change, −35.0) at 2 years, −36.3 kg (95% CI, −39.0 to −33.5; mean percent change, −28.0) at 6 years, and −35.0 kg (95% CI, −38.4 to −31.7; mean percent change, −26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was −2.9 kg (95% CI, −6.9 to 1.0; mean percent change, −2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, −3.5 to 3.5; mean percent change, −0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons). CONCLUSIONS This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.)

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Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study

Cited by 119 publications

References 33 publications

Glucose Metabolism After Gastric Banding and Gastric Bypass in Individuals With Type 2 Diabetes: Weight Loss Effect

Glucose Metabolism After Gastric Banding and Gastric Bypass in Individuals With Type 2 Diabetes: Weight Loss Effect

Reduction in Comorbid Conditions Over 5 Years Following Bariatric Surgery in Medicaid and Commercially Insured Patients

Weight and Metabolic Outcomes 12 Years after Gastric Bypass

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