Clinical Research

Obesity Surgery

, Volume 23, Issue 1, pp 93-102

First online:

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

  • David E. ArterburnAffiliated withGroup Health Research Institute Email author 
  • , Andy BogartAffiliated withGroup Health Research Institute
  • , Nancy E. SherwoodAffiliated withHealthPartners Institute for Education and Research
  • , Stephen SidneyAffiliated withKaiser Permanente Northern California
  • , Karen J. ColemanAffiliated withKaiser Permanente Southern California
  • , Sebastien HaneuseAffiliated withHarvard School of Public Health
  • , Patrick J. O’ConnorAffiliated withHealthPartners Institute for Education and Research
  • , Mary Kay TheisAffiliated withGroup Health Research Institute
  • , Guilherme M. CamposAffiliated withUniversity of Wisconsin
    • , David McCullochAffiliated withGroup Health Research Institute
    • , Joe SelbyAffiliated withPatient Centered Outcomes Research Institute

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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.


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.


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).


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.


Gastric bypass Diabetes Remission Relapse