T2D Remission After Gastric Bypass Persists, Despite Weight Regain
People with T2D and obesity who had gastric bypass surgery maintained significant levels of disease remission, despite up to 100% weight regain, study finds.
In adults with type 2 diabetes (T2D) and obesity undergoing bariatric surgery, those who had a Roux-En-Y gastric bypass (RYGB) procedure were more likely remain in disease remission at 5 years postsurgery, despite significant weight regain, while those who had undergone sleeve gastrectomy (SG) were up to 5 times more likely to shift out of remission.1 The findings come from a new study by researchers at the Mayo Clinic who also reported that overall, remission persisted in 75% of study participants who had RYGB at 5-year follow-up vs just 34.8% of those who had SG.1
RYGB is known to induce high rates of T2D remission, an outcome experts hypothesize is mediated primarily by weight loss, wrote study authors led by Omar M Ghanem, MD, a bariatric and metabolic surgeon at Mayo Clinic in Rochester, Minnesota.1 Compared to procedures such as SG that do not bypass the proximal small-intestines, RYGB is associated with intestinal mechanisms that are independent of weight loss and "conducive to T2DM remission."1
"Bypassing that axis contributes to many physiologic actions or changes in metabolism and one of them is the regulation of glycemia and eventually diabetes,” Dr. Ghanem said in a statement from the American College of Surgeons.2
Ghanem et al conducted a retrospective study to compare rates of continued diabetes remission despite weight recurrence following RYGB and SG.
The researchers reviewed data from 224 individuals who underwent RYGB and 46 who had SG at the Mayo Clinic between 2008 and 2017. All participants had a preoperative diagnosis of T2D and a BMI equal to or greater than 35 kg/m2. The full cohort was followed for up to 5 years at which point Ghanem and colleagues stratified rates of continued diabetes remission into quartiles of weight regained for comparison. The findings are highlighted below.1
acontrolled for age, sex, preoperative duration of T2D, insulin use, HbA1c, fasting glucose, BMI, and weight recurrence percentage. bFactors associated with increased T2D recurrence were baseline insulin dependence (OR, 2.63; 95% CI, 1.17-5.91), higher preoperative A1c (OR, 1.50; 95% CI, 1.10-2.06), and longer preoperative duration of T2D (OR, 1.06; 95% CI, 1.02-1.10).
"Despite weight recurrence not being an independent factor associated with T2D recurrence, its importance cannot be overlooked. Some patients with complete weight recurrence after RYGB maintained significant continued diabetes remission, further supporting a potential role of the proximal small intestines in metabolic control that is less dependent on the weight loss achieved through gastric restriction," wrote the authors in their conclusion.1
“A major determining fact when choosing the most appropriate surgery is if the patient wants to eliminate diabetes or wants to have the least chance of having diabetes come back in the long term,” concluded Ghanem.2 “While both procedures are great, we know that gastric bypass is a better procedure for patients with diabetes at this point.”2
