Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study

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.

Keywords: beta-cell function; diabetes; gastric bypass; laparoscopic gastric band; remission.

Figure 1.

Decision tree for determining diabetes remission status.

Figure 2.

Modeled probabilities and 95% confidence intervals for diabetes remission for each postoperative year (labeled in months) of follow-up as a function of the percentage of weight loss in participants undergoing laparoscopic gastric banding (LAGB, orange lines) and Roux-en-Y gastric bypass (RYGB, blue lines). Adjusted relative risk (aRR) estimates and 95% confidence intervals for the association between surgical type (RYGB vs LAGB) and diabetes remission are adjusted for the percentage of weight change from baseline and the propensity score consisting of baseline demographic and clinical characteristics associated with type of bariatric surgical procedure. aRR is greater for RYGB than LAGB at each postoperative year. For actual aRR and P-values see Table 7.