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Obesity Surgery
Published in: Obesity Surgery 1/2013

01-01-2013 | Clinical Research

A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass

Authors: David E. Arterburn, 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

Published in: Obesity Surgery | Issue 1/2013

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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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Metadata
Title
A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass
Authors
David E. Arterburn
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
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 1/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0802-1

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