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A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass

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Abstract

Background

Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass.

Methods

We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the USA. Remission and relapse events were defined by diabetes medication use and clinical laboratory measures of glycemic control. We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass.

Results

Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p = 0.03).

Conclusions

Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.

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Acknowledgments

The team would like to gratefully acknowledge the contributions of our project managers Rene Hawkes (Group Health Research Institute), Cathy Chou (Kaiser Permanente Northern California), and Mark Pierce (Kaiser Permanente Northern California) and programmers Mary Becker (HealthPartners), Mike Sorel (Kaiser Permanente Northern California), and Julie Liu (Kaiser Permanente Southern California). We would also like to acknowledge the scientific and clinical input of our Technical Expert Panel members: Edward H. Livingston, MD, FACS (University of Texas Southwestern); David R. Flum, MD, MPH, FACS (University of Washington); and Melinda Maggard Gibbons, MD (University of California at Los Angeles).

This research was conducted by Group Health Research Institute, HealthPartners, Kaiser Permanente Northern California, Kaiser Permanente Southern California, and the University of Wisconsin. This project was funded under contract no. HHSA290-2005-0033-I-TO10-WA1 from the Agency for Healthcare Research and Quality, US Department of Health and Human Services as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program.

Conflicts of Interest

None.

Author information

Authors and Affiliations

  1. Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA

    David E. Arterburn, Andy Bogart, Mary Kay Theis & David McCulloch

  2. HealthPartners Institute for Education and Research, Minneapolis, MN, USA

    Nancy E. Sherwood & Patrick J. O’Connor

  3. Kaiser Permanente Northern California, Oakland, CA, USA

    Stephen Sidney

  4. Kaiser Permanente Southern California, Pasadena, CA, USA

    Karen J. Coleman

  5. University of Wisconsin, Madison, WI, USA

    Guilherme M. Campos

  6. Harvard School of Public Health, Boston, MA, USA

    Sebastien Haneuse

  7. Patient Centered Outcomes Research Institute, Washington, DC, USA

    Joe Selby

Authors
  1. David E. Arterburn
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  8. Mary Kay Theis
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  9. Guilherme M. Campos
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Corresponding author

Correspondence to David E. Arterburn.

Appendix

Appendix

Fig. 2
figure 2

Flow of subjects through our study until partial diabetes remission, relapse, and death

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Fig. 3
figure 3

Flow of subjects through our study until complete diabetes remission, relapse, and death

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Fig. 4
figure 4

Body mass index trajectories for gastric bypass patients who never completely remit diabetes, durably remit diabetes, and remit but subsequently relapse diabetes. The left-hand figure presents the unadjusted lowess smoothed BMI trajectories for each group, and the right-hand figure presents the multivariable adjusted and intensity-weighted plots for each group

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Arterburn, D.E., Bogart, A., Sherwood, N.E. et al. A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass. OBES SURG 23, 93–102 (2013). https://doi.org/10.1007/s11695-012-0802-1

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