In patients with diabetes and obesity, bariatric surgery is more likely to lead to durable and long-term diabetes remission when performed immediately after diabetes diagnosis since patients who are early in their disease course often have a lower medication burden and more preserved beta-cell function. This is according to a study in the Journal of Clinical Endocrinology and Metabolism.
The observational study included 827 adult patients with severe obesity who were recruited from 10 US hospitals between 2006 and 2009. Patients underwent either a Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) procedure, and their cases were followed for up to 7 years to compare diabetes prevalence and remission rates. The researchers also examined associations between patient characteristics and remission status.
Approximately 57.2% of patients were in remission from their diabetes at 7 years after RYGB. A smaller proportion of patients were in remission at the 7-year endpoint following LAGB (22.5%).
Patient characteristics at baseline that were associated with long-term diabetes remission included younger age (RYGB: 48.30 vs 51.57 years; P =.0002; LAGB: 49.9 vs 55.76 years; P =.0005), shorter diabetes duration (6.07 vs 13.51 years; P <.0001; LAGB: 4.71 vs 11.08 years; P <.0001), higher C-peptide levels (4.66 vs 2.92 nmol/L; P <.0001; LAGB: 5.10 vs 3.90 nmol/L; P <.0001), higher homeostatic model assessment beta-cell function (HOMA %β; 124.91 vs 107.77; P =.0062; LAGB: 119.70 vs 105.42; P =.002), and lower insulin usage (89% vs 97%; P <.0001).
Long-term diabetes remission was also associated with greater postsurgical weight loss (RYGB: per -10%, risk ratio [RR], 1.11; 95% confidence interval [CI], 1.07-1.15; P <.0001; LAGB: RR, 1.32; 95% CI, 1.16-1.49; P <.0001).
Following LAGB, reduced homeostatic model assessment insulin resistance (HOMA IR) was significantly associated with a greater likelihood of diabetes remission (per -15%; RR, 1.23; 95% CI, 1.12-1.34; P <.0001). After RYGB, increased HOMA %β predicted remission (per -35%; RR, 0.97; 95% CI, 0.96-0.99; P =.0022).
A limitation of this study was the inclusion of a cohort of predominantly women and White patients, which may limit generalizability. The lack of a randomized design represents an additional limitation of the study.
In an analysis adjusted for weight loss, the researchers found that diabetes remission was nearly 4-fold higher after RYGB compared with LAGB, increasing from an adjusted relative risk of 1.86 after the first year to 3.96 after 7 years. The investigators suggest this finding “suggests mechanisms beyond weight loss are contributing to improved beta cell function after RYGB.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Purnell JQ, Dewey EN, Laferrère B, et al. Diabetes remission status during seven-year follow-up of the longitudinal assessment of bariatric surgery study. Published online December 3, 2020. J Clin Endocrinol Metab. doi:10.1210/clinem/dgaa849