Cited by 426Bariatric Surgery and OutcomesDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass

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Arterburn, David E., Bogart, Andy, Sherwood, Nancy E., Sidney, Stephen, Coleman, Karen J., Haneuse, Sebastien, O’Connor, Patrick J., Theis, Mary Kay +3 more·2013·Obesity Surgery

Abstract

Background Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass.Methods We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the USA. Remission and relapse events were defined by diabetes medication use and clinical laboratory measures of glycemic control. We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass.Results Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p = 0.03).Conclusions Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.

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  • The strongest predictor of diabetes remission is duration of diabetes and insulin use prior to surgery rather than weight regain, suggesting underlying β-cell health as a limiting factor for RYGB's antidiabetes benefits.

    “The observation that the strongest predictor of diabetes remission is duration of diabetes and insulin use prior to surgery ( 82 ) rather than weight regain also suggests underlying β-cell health as a limiting factor for RYGB’s antidiabetes benefits.”

    From β-Cell Failure in Type 2 Diabetes: Postulated Mechanisms and Prospects for Prevention and Treatment (2014) · cites this paper as [82]

    The Results (Remission of diabetes; page unavailable) identify longer diabetes duration and preoperative insulin use as significant predictors of lower remission. The paper does not establish that they are the strongest predictors or compare their predictive strength with weight regain; the Discussion says limited BMI data constrained its analysis of weight change. (LLM, conf=0.85)

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  • At 2 years and beyond, approximately 50% of bariatric surgery patients can achieve ongoing diabetes remission.

    “Outcomes at 2 years and beyond indicate ~50% of patients can achieve ongoing diabetes remission (13, 14).”

    From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [14]

    The Results and Discussion (pages unavailable) report that 68.2% of gastric-bypass patients achieved complete diabetes remission within five years, while 35.1% of those who remitted relapsed within five years of remission. Those figures are broadly consistent with approximately half achieving lasting remission, but the paper does not report a ~50% ongoing-remission rate at two years, and its cohort received gastric bypass rather than bariatric surgery generally. (LLM, conf=0.82)

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Authors
Arterburn, D. E., Bogart, A., Sherwood, N. E., Sidney, S., Coleman, K. J., Haneuse, S., O’Connor, P. J., Theis, M. K., Campos, G. M., McCulloch, D., & Selby, J.
Affiliations
  • Kaiser Permanente Washington Health Research Institute (US)
  • HealthPartners (US)
  • Kaiser Permanente (US)
  • Harvard University (US)
  • University of Wisconsin–Madison (US)
  • Patient-Centered Outcomes Research Institute (US)
Corresponding author
Arterburn, David E.
Venue
Obesity Surgery
Published
2012-11-18
Volume
23
Issue
1
Pages
93-102
ISSN
  • 0960-8923 (ISSN-L)
  • 1708-0428
OpenAlex
W1983460753
Cited by
426
References
48
Citations by year
2026: 14 · 2025: 13 · 2024: 17 · 2023: 23 · 2022: 24 · 2021: 31 · 2020: 31 · 2019: 34 · 2018: 27 · 2017: 32 · 2016: 46 · 2015: 40 · 2014: 49 · 2013: 43
FWCI
42.99
Type
journal article
Language
en
Open access
Locations
  • Obesity Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Public Health Service (HHSA290-2005-0033-I-TO10-WA1)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK050456, P30DK092924)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, gastric bypass
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 2, Fasting, Female, Humans, Male, Middle Aged, Obesity, Morbid, Recurrence, Remission Induction, Retrospective Studies, Cohort Studies, Gastric Bypass, Weight Loss, Treatment Outcome

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