Type 2 Diabetes Mellitus Remission after Roux-en-Y Gastric Bypass:A Multi-centered Experience with Long Term Follow Up

Background Roux-en-Y gastric bypass (RYGB) is associated with short- and mid-term type 2 diabetes (T2D) remission. Long-term outcomes and predictive parameters associated with remission following RYGB have not been well elucidated. Objective Determining the overall long-term T2D remission rates following RYGB and identifying predictive variables associated with remission. Setting Multicentered study including patients who underwent RYGB at three tertiary referral centers for bariatric surgery. Methods We performed a retrospective cohort study between 2008-2017 to allow a minimum of 5 years of follow-up. We evaluated long-term T2D remission rates and annual T2D clinical and metabolic parameters up to 14 years after surgery. Predictors of remission were assessed using multivariate logistic regression. Patients were divided into four groups based on quartiles of total body weight loss percentage (%TBWL) to compare remission rates between groups. Results A total of 815 patients were included (68.9% female, age 52.1± 11.5 years; body mass index 45.1± 7.7 kg/m2) with a follow-up of 7.3± 3.8 years. Remission was demonstrated in 51% of patients. Predictors of remission included pre-operative duration of diabetes, baseline HbA1c, insulin use prior to surgery, number of anti-diabetic medications and %TBWL (all p<0.01). Remission rates were proportionally associated with %TBWL quartile [Q1 40.9%, Q2 52.7%, Q3 53.1%, Q4 56.1%] (p=0.02). Conclusions Longer duration and higher severity of T2D were negatively associated with remission while higher %TBWL had a positive association. A significant proportion of patients in all quartiles experienced long-term remission after RYGB with a greater likelihood of remission correlated with greater weight loss.