Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up |
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| Authors: | Mary DiGiorgi Daniel J Rosen Jenny J Choi Luca Milone Beth Schrope Lorraine Olivero-Rivera Nancy Restuccia Sara Yuen McKenzie Fisk William B Inabnet Marc Bessler |
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| Institution: | 1. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;2. Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania;1. Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland;2. University of Maryland School of Medicine, Baltimore, Maryland;3. Department of Surgery, Unaizah College of Medicine, Qassim University, Qassim, Saudi Arabia;4. Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;5. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;6. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;1. Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil;2. Universidade Federal do Rio Grande do Sul, Faculty of Medicine, Graduate Program of Medical Sciences: Endocrinology, Porto Alegre, Rio Grande do Sul, Brazil;1. Diabetes and Obesity Center of Excellence and Veterans Affairs Puget Sound Health Care System, University of Washington School of Medicine, Seattle, WA, USA;2. The Center of Excellence in Bariatric and Metabolic Surgery, Oswaldo Cruz Hospital, São Paulo, Brazil |
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| Abstract: | BackgroundStudies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status.MethodsA review of 42 RYGB patients with T2DM and ≥3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved.ResultsT2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P ≤.0001; and 85% versus 15%; P = .0006, respectively).ConclusionOur results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated. |
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