Abstract
CONTEXT
Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery.
OBJECTIVE
To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB).
DESIGN
An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB.
SETTING
Ten US hospitals.
PARTICIPANTS
A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit.
INTERVENTIONS
Roux-en-Y gastric bypass or LAGB.
MAIN OUTCOME MEASURES
Diabetes rates and associations of patient characteristics with remission status.
RESULTS
Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB.
CONCLUSIONS
Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB.Trial Registration clinicaltrials.gov Identifier: NCT00465829.
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