Diabetes Remission Status during Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study

Jonathan Q. Purnell*, Elizabeth N. Dewey, Blandine Laferrère, Faith Selzer, David R. Flum, James E. Mitchell, Alfons Pomp, Walter J. Pories, Thomas Inge, Anita Courcoulas, Bruce M. Wolfe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Context: Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery. Objective: To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB). Design: An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB. Setting: Ten US hospitals. Participants: A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit. Interventions: Roux-en-Y gastric bypass or LAGB. Main Outcome Measures: Diabetes rates and associations of patient characteristics with remission status. Results: 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 homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (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 4-fold higher compared with LAGB. Conclusions: 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. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB. Trial Registration clinicaltrials.gov Identifier: NCT00465829.

Original languageEnglish (US)
Pages (from-to)774-788
Number of pages15
JournalJournal of Clinical Endocrinology and Metabolism
Volume106
Issue number3
DOIs
StatePublished - Mar 1 2021
Externally publishedYes

Keywords

  • beta-cell function
  • diabetes
  • gastric bypass
  • laparoscopic gastric band
  • remission

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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