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Long-Term Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Surgery on Type 2 Diabetes Mellitus in Morbidly Obese Subjects

Jiménez, Amanda MD*; Casamitjana, Roser PhD*,†,‡; Flores, Lílliam MD, PhD*,†,‡; Viaplana, Judith RN; Corcelles, Ricard MD*; Lacy, Antonio MD, PhD*,‡; Vidal, Josep MD, PhD*,†,‡

doi: 10.1097/SLA.0b013e318262ee6b
Original Articles

Objective: To identify the rates and the predictors of long-term remission and the recurrence of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP) or sleeve gastrectomy (SG).

Background: The durability of the improvement of T2DM after bariatric surgery is not well characterized.

Methods: One hundred fifty-three subjects with T2DM (RYGBP: n = 98; SG: n = 55) were evaluated for remission and recurrence of the disease throughout 35.4 ± 13.5 months' follow-up. The type of surgery, demographic, anthropometric, and biochemical parameters were ascertained as predictors of T2DM outcomes. Glucagon-like peptide 1 (GLP-1) responses after a standard mixed liquid meal were compared between patients presenting with T2DM remission after RYGBP or SG.

Results: 75.2% of subjects presented with remission of T2DM lasting at least 12 months. However, in 12.1% of subjects, T2DM recurred. Regression analysis showed a longer duration of T2DM (P = 0.006), a higher presurgical glycated hemoglobin level (P = 0.019), insulin treatment at baseline (P = 0.001), and a lower excess weight loss at last follow-up visit (P < 0.001) as independent predictors for the lack of T2DM remission. Insulin use before surgery (P = 0.005), an older age (P = 0.05), and weight regain after remission (P = 0.021) predicted recurrence of the disease. Long-term remission of T2DM after SG or RYGBP was associated with a comparably enlarged GLP-1 response to a standard mixed liquid meal challenge.

Conclusions: Roux-en-Y gastric bypass and SG are associated with comparable remission rates of T2DM. However, insufficient weight loss or weight regain in those with a more advanced disease may hamper the benefits of these surgical techniques on T2DM.

Roux-en-Y gastric bypass and sleeve gastrectomy are associated with comparable long-term remission rates of type 2 diabetes mellitus (T2DM). However, in those with a more advanced disease, insufficient weight loss or weight regain may hamper the benefits of these surgical techniques on T2DM.

*Obesity Unit, Hospital Clinic Universitari

Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)

Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.

Reprints: Josep Vidal, MD, PhD, Obesity Unit, Endocrinology and Diabetes Department, Hospital Clínic Universitari, Villarroel 170, 08036 Barcelona, Spain. E-mail: jovidal@clinic.ub.es.

Disclosure: This work was supported by a grant from the Fundación Mutua Madrileña (AP62572009), Madrid, Spain.

© 2012 Lippincott Williams & Wilkins, Inc.