Predictors of Long-Term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass in Severely Obese Patients
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Diabetes remission is not observed in all obese patients with type 2 diabetes submitted to bariatric surgery. Relapses occur in patients in whom remission is achieved. We investigated the factors associated with long-term (≥3 years) remission and relapse of type 2 diabetes after Roux-en-Y gastric bypass (RYGB) in these patients.
By a retrospective review, we analyzed data from 254 patients with type 2 diabetes who had undergone RYGB from May 2000 to November 2011 and had at least 3 years of follow-up. The criteria for remission and relapse of type 2 diabetes followed the current American Diabetes Association recommendations.
Remission was achieved in almost 82% of participants (69.7% complete, and 12.2% partial remission). Of these, 12% relapsed within a mean follow-up of 5.1 ± 2.0 years after surgery. Predictors of complete remission were younger age, better preoperative glycemic control, and shorter diabetes duration. Preoperative insulin use was associated with a ninefold increase in the relapse hazard (HR = 9.1 (95% CI: 3.3–25.4)). Use of two or more oral anti-diabetic agents increased the relapse hazard sixfold (HR = 6.1 (95% CI: 1.8–20.6)). Eighteen point one percent of patients did not achieve any remission during follow-up. However, they exhibited significant improvements in glycemic control.
These data indicate that RYGB should not be delayed when remission of type 2 diabetes is a therapeutic goal, and also suggest that the best possible metabolic control should be sought in obese patients who may eventually be candidates for RYGB.
KeywordsDiabetes Bypass Bariatric surgery Remission Relapse
Compliance with Ethical Standards
This study received funding from the Brazilian National Research and Development Council (CNPq).
Conflict of Interest
Dr. Lopes Preto de Oliveira was the recipient of a grant from the Brazilian National Research and Development Council (CNPq); Gianluca Pioli Martins was the recipient of a grant from the Brazilian National Research and Development Council (CNPq); Dr. Rizzolli has nothing to disclose; Dr. Mottin has nothing to disclose; Dr. Friedman reports grants from this study. It received funding from the Brazilian National Research and Development Council (CNPq) during the conduct of the study.
All procedures were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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