Preoperative duration of type 2 diabetes mellitus and remission after Roux-en-Y gastric bypass: a single center long-term cohort study

Abstract

Background: Roux-en-Y gastric bypass (RYGB) has demonstrated excellent glycemic control and type 2 diabetes mellitus (T2DM) remission for patients with obesity and T2DM. Duration of T2DM is a consistent negative predictor of remission after RYGB. However, the exact timing to offer surgical intervention during the course of the disease is not well elucidated.

Material and methods: The authors performed a retrospective cohort study between 2008 and 2020 to establish the exact association between duration of T2DM and remission after RYGB. The authors divided our cohort into quartiles of preoperative disease duration to quantify the change in remission rates for each year of delay between T2DM diagnosis and RYGB. The authors also compared the average time to remission and changes in glycemic control parameters.

Results: A total of 519 patients (67.2% female; age 53.4±10.7 year; BMI 46.6±8.4 kg/m 2 ) with a follow-up period of 6.6±3.8 years were included. Remission was demonstrated in 51% of patients. Longer duration of T2DM was a significant negative predictor of remission with an estimated decrease in remission rates of 7% for each year of delay [(OR=0.931 (95% CI: 0.892-0.971); P< 0.001)]. Compared to patients with <3 years of T2DM, remission decreased by 37% for patients with 3-6 years, 64% for those with 7-12 years, and 81% for patients with more than 12 years ( P <0.001). Half of the patients reached T2DM remission after 0.5 and 1.1 years, respectively, for the first and second quartiles, while patients in the other quartiles never reached 50% remission. Lastly, The authors noted an overall improvement in all glycemic control parameters for all quartiles at last follow-up.

Conclusion: Patients with a recent history of T2DM who undergo early RYGB experience significantly higher and earlier T2DM remission compared to patients with a prolonged history of preoperative T2DM, suggesting potential benefit of early surgical intervention to manage patients with obesity and T2DM.

Figure 1

Functional form of association of duration of T2DM with remission status.

Figure 2

Kaplan–Meier curves for T2DM remission rates in each group. Group 1: <3 years duration of preoperative T2DM; Group 2: 3–6 years duration of preoperative T2DM; Group 3: 7–12 years duration of preoperative T2DM; Group 4: >12 years duration of preoperative T2DM.

Figure 3

Cumulative T2DM remission rates for each quartile. A. Quartile 1: <3 years duration of preoperative T2DM; B. Quartile 2: 3–6 years duration of preoperative T2DM; C. Quartile 3: 7–12 years duration of preoperative T2DM; D. Quartile 4: >12 years duration of preoperative T2DM.