More Weight Loss After Gastric Bypass Linked to Better Chance of T2DM Remission

By Reuters Staff

November 12, 2019

NEW YORK (Reuters Health) - Younger patients and those who lose more weight in the first year after Roux-en-Y gastric bypass (RYGB) have a better chance of achieving lasting type 2 diabetes mellitus (T2D) remission, new research shows.

Patients who used insulin before the surgery were more likely to have relapse, Dr. Guilherme M. Campos of Virginia Commonwealth University in Richmond and colleagues found.

"Referring patients at a younger age, before insulin is needed, and optimizing both weight loss and weight maintenance after RYGB may improve the rates and durability of T2D remission," Dr. Campos and colleagues write in the Journal of the American College of Surgeons, online October 28. The findings were also presented at the ACS Clinical Congress 2019 in San Francisco.

More than half of patients who undergo RYGB have remission of T2D, the authors note, but about one-third of them relapse.

"Given that T2D remission and relapse rates appear to plateau three and nine years after RYGB, respectively, shorter follow-up periods may be insufficient to capture a considerable proportion of patients at risk for relapse of T2D," they add.

The authors looked at 621 patients who underwent RYGB at their hospital, with a median follow-up of 4.9 years.

Seventy-seven percent achieved T2D remission. Prevalence of remission was 74% at one year, 73% at one to three years, 63% at three to 10 years and 47% after 10 years.

Remission lasted a median six years, and for up to 22.4 years. The median time to relapse was 5.3 years after remission and 6.5 years after surgery.

The relapse rate was 5% in the first three years, 19% at three to 10 years and 34% after 10 years.

Independent factors linked to T2D remission included being younger at the time of surgery, not using insulin, and a greater percentage of body weight lost at one year. Patients who were in remission for three to 10 years gained about 5% of the weight they had lost in the first year after surgery, compared to nearly quadruple that amount for patients who relapsed.

Relapse was also independently associated with using insulin before surgery, losing a lower percentage of total body weight (%TBW), and gaining a higher %TBW three to 10 years after surgery.

"The present results point to a strong interdependence of weight loss, weight regain, and T2D outcomes after RYGB," the authors write.


J Am Coll Surg 2019.