Obesity Surgery

, Volume 29, Issue 4, pp 1164–1168 | Cite as

Risk Factors for Relapse of Hyperglycemia after Laparoscopic Roux-en-Y Gastric Bypass in T2DM Obese Patients: a 5-Year Follow-Up of 24 Cases

  • Wang Xiaosong
  • Su Chongyu
  • Shen Xuqi
  • Yu PeiwuEmail author
  • Zhao YongliangEmail author
Original Contributions



To explore the risk factors for relapse of hyperglycemia in obese patients with type II diabetes mellitus (T2DM) who received laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.


A retrospective analysis was performed on all obese patients with T2DM who underwent a LRYGB during the period 2011–2013. Demographics, preoperative body mass index (BMI), preoperative glycated hemoglobin A1c (HbA1c), adherence to lifestyle intervention, preoperative medication of insulin, and the time interval between surgery and diagnosis of T2DM were investigated and compared.


A total of 24 patients were included in our study. The median age was 45.5 years, the median BMI was 29.9 kg/m2, and the median HbA1c was 7.9%. Out of 24 patients, 54.2% (13/24) experienced a relapse of hyperglycemia. The 1-year, 3-year, and 5-year relapse rates were 4.2%, 12.5%, and 50.0%, respectively. The preoperative HbA1c level, C-peptide (2 h) level, and C-peptide (3 h) level were identified as independent variables for the relapse of hyperglycemia (8.11 ± 0.48 vs 7.72 ± 0.37 kg/m2, p = 0.036; 4.35 ± 1.46 vs 7.13 ± 4.10 ng/ml, p = 0.032; 3.76 ± 0.61 vs 5.99 ± 3.39 ng/ml, p = 0.029). Lifestyle intervention could reduce the hyperglycemia relapse rate (66.7 vs 41.7%) after LRYGB surgery.


The preoperative HbA1c level and C-peptide level at surgery have an important significance in predicting the relapse of hyperglycemia after LRYGB surgery; lifestyle intervention is crucial for these patients.


Recurrence of T2DM Obesity LRYGB 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Baena-Díez JM, Peñafiel J, Subirana I, Ramos R, Elosua R, Marín-Ibañez A, Guembe MJ, Rigo F, Tormo-Díaz MJ, Moreno-Iribas C, Cabré JJ, Segura A, García-Lareo M, Gómez de la Cámara A, Lapetra J, Quesada M, Marrugat J, Medrano MJ, Berjón J, Frontera G, Gavrila D, Barricarte A, Basora J, García JM, Pavone NC, Lora-Pablos D, Mayoral E, Franch J, Mata M, Castell C, Frances A, Grau M, FRESCO Investigators. Risk of cause-specific death in individuals with diabetes: a competing risks analysis [J]. Diabetes Care, 2016, 39(11): 1987, 1995.Google Scholar
  2. 2.
    Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045 [J]. Diabetes Res Clin Pract. 2018;138:271–81.CrossRefGoogle Scholar
  3. 3.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial [J]. Lancet. 2015;386(9997):964–73.CrossRefGoogle Scholar
  4. 4.
    Aminian A, Brethauer SA, Andalib A, Punchai S, Mackey J, Rodriguez J, Rogula T, Kroh M, Schauer PR Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes [J]. Ann Surg, 2016, 264(4): 674, 681.Google Scholar
  5. 5.
    Brethauer SA, Aminian A, Romero-Talamã s H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus [J]. Ann Surg, 2013, 258(4): 636–637.Google Scholar
  6. 6.
    Buse JB, Caprio S, Cefalu WT, Ceriello A, del Prato S, Inzucchi SE, McLaughlin S, Phillips GL, Robertson RP, Rubino F, Kahn R, Kirkman MS How do we define cure of diabetes? [J]. Diabetes Care, 2009, 32(11): 2133–2135.Google Scholar
  7. 7.
    Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus [J]. Ann Surg, 2003, 238(4): 467–484.Google Scholar
  8. 8.
    Rubino F, Kaplan LM, Schauer PR, et al. The diabetes surgery summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus [J]. Ann Surg. 2010;251(3):399–405.CrossRefGoogle Scholar
  9. 9.
    Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes [J]. Arquivos Brasileiros De Endocrinologia E Metabologia. 2011;5(3):e171–89.Google Scholar
  10. 10.
    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes [J]. N Engl J Med. 2012;366(17):1567–76.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Pournaras DJ, Aasheim ET, Søvik TT, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2012 Jan;99(1):100–3.CrossRefGoogle Scholar
  12. 12.
    Digiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up [J]. Surg Obes Relat Dis. 2010;6(3):249–53.CrossRefGoogle Scholar
  13. 13.
    Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass [J]. Surg Obes Relat Dis. 2010;6(3):254–9.CrossRefGoogle Scholar
  14. 14.
    Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic [J]. Nature. 2001;414(6865):782–7.CrossRefGoogle Scholar
  15. 15.
    Pournaras DJ, Osborne A, Hawkins SC, et al. Remission of type 2 diabetes after gastric bypass and banding: mechanisms and 2 year outcomes [J]. Ann Surg. 2010;252(6):966–71.CrossRefGoogle Scholar
  16. 16.
    Rosenthal R, Li X, Samuel S, et al. Effect of sleeve gastrectomy on patients with diabetes mellitus [J]. Surg Obes Relat Dis. 2009;5(4):429–34.CrossRefGoogle Scholar
  17. 17.
    Hall TC, Pellen MG, Sedman PC, et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity [J]. Obes Surg. 2010;20(9):1245–50.CrossRefGoogle Scholar
  18. 18.
    Aarts EO. Janssen, et al. Preoperative fasting plasma C-peptide level may help to predict diabetes outcome after gastric bypass surgery [J]. Obes Surg. 2013;23(7):867–73.CrossRefGoogle Scholar
  19. 19.
    Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion [J]. Surgery. 2010;147(5):664–9.CrossRefGoogle Scholar
  20. 20.
    Huang CK, Asim S, Chi-Hsien L, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25–35 [J]. Obes Surg. 2011;21(9):1344–9.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Sjöström ML, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events [J]. Jama. 2012;307(1):56–65.CrossRefGoogle Scholar
  22. 22.
    Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score [J]. Surg Obes Relat Dis. 2013;9(3):379–84.CrossRefGoogle Scholar
  23. 23.
    National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998 Sep;6 Suppl 2:51S–209SGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General surgeryThe First Hospital Affiliated to Army Medical UniversityChongqingChina

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