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Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study - PubMed

Observational Study

Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study

Jonathan Q Purnell et al. Diabetes Care. 2016 Jul.

Abstract

Objective: The goals of this study were to determine baseline and postbariatric surgical characteristics associated with type 2 diabetes remission and if, after controlling for differences in weight loss, diabetes remission was greater after Roux-en-Y gastric bypass (RYGBP) than laparoscopic gastric banding (LAGB).

Research design and methods: An observational cohort of obese participants was studied using generalized linear mixed models to examine the associations of bariatric surgery type and diabetes remission rates for up to 3 years. Of 2,458 obese participants enrolled, 1,868 (76%) had complete data to assess diabetes status at both baseline and at least one follow-up visit. Of these, 627 participants (34%) were classified with diabetes: 466 underwent RYGBP and 140 underwent LAGB.

Results: After 3 years, 68.7% of RYGBP and 30.2% of LAGB participants were in diabetes remission. Baseline factors associated with diabetes remission included a lower weight for LAGB, greater fasting C-peptide, lower leptin-to-fat mass ratio for RYGBP, and a lower hemoglobin A1c without need for insulin for both procedures. After both procedures, greater postsurgical weight loss was associated with remission. However, even after controlling for differences in amount of weight lost, relative diabetes remission rates remained nearly twofold higher after RYGBP than LAGB.

Conclusions: Diabetes remission up to 3 years after RYGBP and LAGB was proportionally higher with increasing postsurgical weight loss. However, the nearly twofold greater weight loss-adjusted likelihood of diabetes remission in subjects undergoing RYGBP than LAGB suggests unique mechanisms contributing to improved glucose metabolism beyond weight loss after RYGBP.

© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

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Figures

Figure 1
Figure 1

Modeled probabilities and 95% CIs for diabetes remission for each postoperative year of follow-up as a function of percent weight loss in participants undergoing LAGB (red lines) and RYGBP (blue lines). aRR estimates and 95% CIs for the association between surgical type (RYGBP vs. LAGB) and diabetes remission are adjusted for percent weight change from baseline and a propensity score consisting of baseline demographic and clinical characteristics associated with type of bariatric surgical procedure. aRR is greater for RYGBP than LAGB at each postoperative year; P ≤ 0.001 for each time point.

Figure 2
Figure 2

Box plots displaying levels of leptin adjusted for fat mass before and yearly for 3 years after undergoing LAGB (left graph, red bars) and RYGBP (right graph, blue bars). Overall test for change from baseline over time accounting for within-participant correlation: P < 0.001 for RYGBP and P = 0.40 for LAGB.

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