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Predictors of Long-Term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass in Severely Obese Patients

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Post-Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Porto Alegre, Brazil

    Vanessa Lopes Preto de Oliveira & Rogério Friedman

  2. Division of Endocrinology, Hospital São Lucas da Pontifícia Universidade do Rio Grande do Sul, Av. Ipiranga, 6690, Sala 220, 2° andar, Porto Alegre, RS, 90610-000, Brazil

    Vanessa Lopes Preto de Oliveira & Jacqueline Rizzolli

  3. Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, Brazil

    Gianluca P. Martins & Rogério Friedman

  4. Obesity and Metabolic Syndrome Center, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6.690, Centro Clínico da PUC, 3°andar, Sala 302, Porto Alegre, Brazil

    Cláudio C. Mottin & Jacqueline Rizzolli

  5. Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350 Sala 401, Porto Alegre, Brazil

    Rogério Friedman

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  1. Vanessa Lopes Preto de Oliveira
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  2. Gianluca P. Martins
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  3. Cláudio C. Mottin
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  4. Jacqueline Rizzolli
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Correspondence to Vanessa Lopes Preto de Oliveira.

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Funding

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.

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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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de Oliveira, V.L.P., Martins, G.P., Mottin, C.C. et al. Predictors of Long-Term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass in Severely Obese Patients. OBES SURG 28, 195–203 (2018). https://doi.org/10.1007/s11695-017-2830-3

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