Is Remission of Type II Diabetes Mellitus after Laparoscopic Roux-en-Y Gastric Bypass Associated with Weight Loss and Weight Regain?

Shaina R Eckhouse, MD, Leonor Corsino, MD, FACE, MHS, Alfredo D Guerron, MD, Nova Szoka, MD, John Grant, MD, Keri Seymour, DO, Chan W Park, MD, Jin Yoo, MD, Ranjan Sudan, MD, Dana D Portenier, MD. Duke Universtiy

BACKGROUND:

Previous studies demonstrated that metabolic syndrome (hypertension, obesity, elevated lipids, diabetes) improve in patients undergoing a Roux-en-Y gastric bypass (RGB).   Also, an association between weight loss and improvements in Type 2 Diabetes Mellitus (T2DM) has been suggested, but the mechanism is not fully elucidated. Insufficient weight loss and weight regain can affect 15 to 35% of patients after RGB.  To date, no long-term studies have looked at the correlation between weight recidivism and diabetic control. The present study hypothesizes that weight recidivism would be associated with a worsening diabetic control.

METHODS:

This was a single institution retrospective study of morbidly obese patients with T2DM who underwent RGB between January 2000 and July 2004 and were followed for at least 10years.  Weight loss, weight regain, and markers of diabetes management were evaluated.

RESULTS:

Of the 173patients with T2DM undergoing RGB during the study period, 76patients agreed to participate and were followed for 10years.   Both BMI and percentage of excess weight loss (%EWL) significantly improved over the 10year study period (p=0.05 and p=0.003, respectively).  The largest %EWL was noted 1-2years after the RGB.   An average of 17±3% weight regain occurred after 2years until the end of the study period.  During this time, both the number of T2DM medications and Hemoglobin A1C significantly decreased after RGB (p<0.0001).  Of the 49 initial patients with remission after RGB, 13 (27%) required re-initiation of medical management by 10years post-operatively. 36 of the 76patients (47%) had complete remission of T2DM while 10 (13%) met criteria for partial remission.  Importantly, no difference in weight regain was identified between patients with remission or relapse of T2DM.

Weigh Gain and T2DM 10years after RGB.
  No Weight Gain Weight Gain
Remission 16–44% 20–56%
Partial Remission 2–20% 8–80%
T2DM 8–27% 22–73%
   Relapse 4 9
   Persistent T2DM 4 13

X2 analysis; p=0.38

CONCLUSIONS:

Significant improvement is seen after RGB with both improved weight and T2DM remission.  However, a percentage of patients will regain weight, and a percentage of patients will require continued or re-initiation of medical management of T2DM.   Surprisingly, a cause-effect relationship was not identified in this study between these two factors.   Therefore, RGB is an effective surgical treatment for T2DM independent of weight recidivism.

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