Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery

Abstract Background Defining factors associated with remission and relapse of type 2 diabetes (T2D) after gastric bypass (RYGB) may allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. Study Design Retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medications discontinuation and/or HbA1c Results 621 patients (aged 46.7±10.6 years; 30% on insulin; BMI 49.8±8.3 kg/m2) had at least one-year follow-up. Median follow-up was 4.9 (range 1-23.6) years. Prevalence of T2D remission was 74% at one year, 73% from one to three years, 63% between 3 and 10 years, and 47% beyond 10 years. 93% of remissions occurred within 3 years of RYGB, 25% relapsed. The median (IQR) time to relapse was 5.3 (3-7.8) years after remission. Higher one-year percentage total body weight (%TBW) loss, lack of preoperative insulin use, and younger age at surgery were independently associated with T2D remission. Preoperative insulin use, lower %TBW loss at one year, and greater %TBW gain after one year were independently associated with T2D relapse. Conclusion This longitudinal retrospective analysis shows that preoperative insulin use and age, one-year weight loss, and regain after that influence T2D remission and relapse following RYGB. 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.