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Multicenter Study
. 2013 Jan;23(1):93-102.
doi: 10.1007/s11695-012-0802-1.

A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass

David E Arterburn  1 , Andy Bogart, Nancy E Sherwood, Stephen Sidney, Karen J Coleman, Sebastien Haneuse, Patrick J O'Connor, Mary Kay Theis, Guilherme M Campos, David McCulloch, Joe Selby
Affiliations
Multicenter Study

A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass

David E Arterburn et al. Obes Surg. 2013 Jan.

Abstract

Background: Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass.

Methods: We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the USA. Remission and relapse events were defined by diabetes medication use and clinical laboratory measures of glycemic control. We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass.

Results: Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p = 0.03).

Conclusions: Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.

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Figures

Figure 1
Figure 1
Right-hand Panels. Time to relapse of diabetes following bariatric surgery and initial complete remission, overall and by baseline control status Figure 1. Left-hand Panels. Time to complete diabetes remission following bariatric surgery, overall and by baseline control status
Figure 1
Figure 1
Right-hand Panels. Time to relapse of diabetes following bariatric surgery and initial complete remission, overall and by baseline control status Figure 1. Left-hand Panels. Time to complete diabetes remission following bariatric surgery, overall and by baseline control status
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