Gastric Bypass Surgery Tied to Diabetes Remission

By Lisa Rapaport

March 04, 2019

(Reuters Health) - Three in four obese people with diabetes who underwent Roux-en-Y gastric bypass (RYGB) experienced remission of their diabetes within a year after surgery, a Danish study found.

Five years later, 27% of those who achieved remission had relapsed, the study also found. However, the total proportion of people in remission held steady, suggesting that some people achieved remission later and remained free of diabetes symptoms.

"We have known for some years from smaller studies . . . that Roux-en-Y gastric bypass surgery has the ability to make type 2 diabetes go into remission," said lead study author Dr. Lene Ring Madsen of Aarhus University in Denmark.

"The novelty of our study is that we can confirm these results in large real-world cohorts of unselected patients with severe obesity and type 2 diabetes," Madsen said by email.

In the current study, researchers examined data on 1,111 people with type 2 diabetes who had RYGB operations between 2006 and 2015.

Patients were more likely to achieve diabetes remission after surgery when they were younger, had been living with diabetes for shorter periods of time, and had less severe diabetes. Men also did better than women.

Within six months of surgery, 65% of patients had their diabetes go into remission. This rate rose to 74% over the next six months and remained there for the rest of the study period.

Diabetics who required insulin before their weight-loss surgery had 43% lower remission rates than patients who didn't need insulin, the study also found.

Compared to 1,074 similar obese patients with type 2 diabetes who didn't have RYGB surgery, those who did were less likely to develop microvascular complications like kidney or eye disease. With surgery, the risk of retinopathy was 48% lower and the chance of kidney disease was 46% lower.

Within 30 days of surgery, 7.5% of patients had repeat hospitalizations for complications related to the gastric bypass procedures.

The study, reported online February 6 in Diabetologia, suggests that obese people with diabetes may not necessarily want to wait to have surgery if they're considering this option, since their chance of remission goes down the longer they live with diabetes, said Dr. Sheri Colberg of Old Dominion University in Norfolk, Virginia.

"The earlier after diabetes diagnosis that gastric bypass surgery is done, the greater its potential impact on preventing many diabetes-related health complications," Colberg, who wasn't involved in the study, said by email.

"Given that it involves major abdominal surgery, having a gastric bypass procedure is certainly not without some major health risks, including short-term complications from the surgery itself and longer-term ones like micronutrient deficiencies due to malabsorption of vitamins and minerals in the diet," Colberg added.

"This study does suggest that more than half of patients undergoing such surgeries were able to remain diabetes-free, which reduces their risk of the long-term health complications associated with diabetes," Colberg said. "Patients who are unable to lose weight any other way may benefit more than those who can lose weight (and reverse diabetes or limit its impact) via adopting a healthier lifestyle -- it will need to be an individual choice and is certainly not for everyone."


Diabetologia 2019.