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).