Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12 Years Follow-up Study

Abstract

Background

Roux-en-Y gastric bypass (RYGB) is a recommended treatment for type 2 diabetes mellitus (T2DM) in patients with obesity, with superiority over medical therapy. While diabetes remission is achieved initially in 60–90% of patients following surgery, many may experience relapse of diabetes on the long-term. Data on long-term follow-up of bariatric surgery is scarce. We report this 12-year follow-up study of glycaemic control following RYGB.

Methods

Two hundred seventeen patients with obesity (109 diabetic, 108 matched nondiabetic) who underwent RYGB between 2000 and 2008 were identified. Data was recorded prospectively for these patients at baseline and 2 years postoperatively. The long-term data was obtained via direct contact with the patients cross-checked with our hospital/national patients’ electronic databases.

Results

The follow-up rate was 88% (initial age 44 ± 9 years, female 79%). The mean (± SD) percentage total weight loss was 28% (± 15%) and 27% (± 17%) at 2 years and 12 years, respectively. Diabetes remission rate was 69% at 2 years, but decreased to 36% at 12 years following surgery. The 12-year incidence of new-onset T2DM in the control group was 4.3%. On univariate analysis, age, preoperative duration of diabetes and use of insulin were associated with less chance of diabetes remission at long-term (p value 0.06, 0.01 and 0.03, respectively). However, on multivariate regression analysis, only the duration of diabetes preoperatively remained significant (p = 0.025).

Conclusion

This study shows a high relapse of diabetes 12-year post-RYGB despite the durability of weight loss. This affects preoperative counselling and indicates a need for a longer follow-up to detect relapse.

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Correspondence to Prashant Jain.

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Conflict of Interest

All authors (Ahmed Mohammed Elshaer, Muhammad Qutayba Almerie, Michael Pellen, Prashant Jain) have no conflict of interest to declare. Results were presented at BOMSS congress 2020 (poster) and accepted at IFSO-European chapter congress 2020 (oral).

Ethics and Consent Information

All work involving the participants in this study was in accordance with the ethical standards of our institution and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study to use their data in our research work.

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Elshaer, A.M., Almerie, M.Q., Pellen, M. et al. Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12 Years Follow-up Study. OBES SURG (2020). https://doi.org/10.1007/s11695-020-04782-z

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Keywords

  • Diabetes mellitus
  • Roux-en-Y gastric bypass
  • Morbid obesity
  • Bariatric surgery
  • Remission