Analysis of factors associated with durable remission of diabetes after Roux-en- Y gastric bypass

Abstract

Background Data on the durability of remission of type 2 diabetes mellitus (T2DM) after gastric bypass are limited. Our purpose was to identify the rate of long-term remission of T2DM and the factors associated with durable remission. Methods A total of 177 patients with T2DM who had undergone Roux-en- Y gastric bypass from 1993 to 2003 had 5-year follow-up data available. T2DM status was determined by interview and evaluation of the diabetic medications. Patients with complete remission or recurrence of T2DM were identified. Results Follow-up ranged from 5 to 16 years. Of the 177 patients, 157 (89%) had complete remission of T2DM with a decrease in their mean body mass index from baseline (50.2 ± 8.2 kg/m 2) to 31.3 ± 7.2 kg/m 2 postoperatively (mean percentage of excess weight loss 70.0% ± 18.6%). However, 20 patients (11.3%) did not have T2DM remission despite a mean percentage of excess weight loss of 58.2% ± 12.3% ( P <.0009). Of the 157 patients with initial remission of their T2DM, 68 (43%) subsequently developed T2DM recurrence. Remission of T2DM was durable in 56.9%. Durable (>5-year) resolution of T2DM was greatest in the patients who originally had either controlled their T2DM with diet (76%) or oral hypoglycemic agents (66%). The rate of T2DM remission was more likely to be durable in men ( P = .00381). Weight regain was a statistically significant, but weak predictor, of T2DM recurrence. Conclusion Early remission of T2DM occurred in 89% of patients after Roux-en- Y gastric bypass. T2DM recurred in 43.1%. Durable remission correlated most closely with an early disease stage at gastric bypass.