Obesity Surgery

, Volume 23, Issue 1, pp 93–102

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

Authors

    • Group Health Research Institute
  • Andy Bogart
    • Group Health Research Institute
  • Nancy E. Sherwood
    • HealthPartners Institute for Education and Research
  • Stephen Sidney
    • Kaiser Permanente Northern California
  • Karen J. Coleman
    • Kaiser Permanente Southern California
  • Sebastien Haneuse
    • Harvard School of Public Health
  • Patrick J. O’Connor
    • HealthPartners Institute for Education and Research
  • Mary Kay Theis
    • Group Health Research Institute
  • Guilherme M. Campos
    • University of Wisconsin
  • David McCulloch
    • Group Health Research Institute
  • Joe Selby
    • Patient Centered Outcomes Research Institute
Clinical Research

DOI: 10.1007/s11695-012-0802-1

Cite this article as:
Arterburn, D.E., Bogart, A., Sherwood, N.E. et al. OBES SURG (2013) 23: 93. doi:10.1007/s11695-012-0802-1

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.

Keywords

Gastric bypass Diabetes Remission Relapse

Copyright information

© Springer Science+Business Media New York 2012