Roux-en-Y Gastric Bypass Associated With Fewer Complications in T2D

bariatric operation using laparoscopic equipment
laparoscopic equipment, bariatric surgery, gastric bypass
Roux-en-Y gastric bypass surgery is associated with remission from type 2 diabetes and substantially reduced the risk for microvascular complications.

Roux-en-Y gastric bypass (RYGB) surgery is associated with remission from type 2 diabetes (T2D) and substantially reduced the risk for microvascular complications, according to study results published in Diabetologia.

In this population-based observational cohort study of individuals with T2D living in Northern Denmark, investigators identified patients aged >18 years with T2D based on prescriptions of ≥1 glucose-lowering drug from January 2006 to December 2015. Patients registered with a procedure code for RYGB (n = 1111) were matched with a comparison cohort comprised of patients with T2D not treated with bariatric surgery during the study period (n = 1074).

The median glycated hemoglobin levels and proportion of microvascular complications were similar at baseline between the 2 cohorts, while use of blood-pressure-lowering drugs and macrovascular complications were more prevalent in the RYGB cohort. Each individual was categorized as being in diabetes remission (defined as no use of a glucose-lowering drug and a hemoglobin A1c level <48 mmol/mol) or nonremission at every 6-month increment after the index date. There was a median follow-up time of 5.3 years in the RYGB cohort and 5.2 years in the comparison cohort.

In the first 6 months after RYGB surgery, 65% of the RYGB cohort fulfilled criteria for remission, which increased to 74% at 6 to 12 months and surpassed 70% at every 6-month period in the first 5 years. After the first year in remission, 73% remained in remission 5 years after bariatric surgery. The RYGB cohort also had a 47% lower risk for microvascular complications (hazard ratio, 0.53; 95% CI, 0.38-0.73) and a 24% lower risk for macrovascular complications (hazard ratio, 0.76; 95% CI, 0.49-1.18) vs the comparison cohort.

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This study was limited by the lack of individual-level data on body mass index in the registries and lack of statistical power to calculate adjusted hazard ratios for individual micro- and macrovascular complications. Nevertheless, the finding of a 47% lower risk for incident microvascular complications after RYGB surgery aligns with and confirms data from previous studies.

Based on these findings, “RYGB does remit [T2D] and is associated with a reduced risk [for] microvascular, and possibly macrovascular, complications… especially if introducing surgery at an early stage of disease,” wrote the researchers. “On the other hand, there is a substantial risk of relapsing into type 2 diabetes, which should be accounted for when advising patients and planning post-surgery care.”

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Madsen LR, Baggesen LM, Richelsen B, Thomsen RW. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study [published online February 6, 2019]. Diabetologia. doi:10.1007/s00125-019-4816-2