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RYGB leads to long-term weight-independent diabetes remission

Thu, 12/03/2020 - 09:20
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More than half of adults with type 2 diabetes had long-term remission following Roux-en-Y gastric bypass (RYGB) surgery, according to researchers from Oregon Health & Science University in Portland, OR. They reported that greater weight-independent likelihood of diabetes remission after RYGB indicates mechanisms beyond weight loss are contributing to improved beta cell function after the procedure.

 The outcomes were published in the paper, ‘Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study’, in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

"If a patient with type 2 diabetes is considering weight loss surgery, choosing gastric bypass soon after diagnosis can increase their chance of remission or achieving a blood sugar level that does not need treatment," said study author, Dr Jonathan Q Purnell from the Oregon Health & Science University. "Our large study confirms the importance of weight loss on inducing diabetes remission, but also finds gastric bypass has benefits independent of weight. If we can understand what these benefits are, it could lead to new diabetes treatments."

For the study, Purnell and colleagues examined 2,256 adults with severe obesity who completed annual research assessments for up to seven years after bariatric surgery, roughly 35 percent of whom had type 2 diabetes. They compared diabetes prevalence and remission rates during those seven years of follow-up after RYGB and laparoscopic gastric banding (LAGB).

At seven years, they found that diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher HOMA %B, and lower insulin usage at baseline, and with greater post-surgical weight loss.

After LAGB, reduced HOMA IR was associated with a greater likelihood of diabetes remission whereas increased HOMA %B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly four-fold higher after RYGB, compared to LAGB. In addition, the researchers found a greater likelihood of diabetes remission after RYGB independent of weight loss, suggesting mechanisms beyond weight loss are contributing to improved blood sugar levels.

“Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved,” they concluded. “A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss are contributing to improved beta cell function after RYGB.”