Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up

Mary Digiorgi, Daniel J. Rosen, Jenny J. Choi, Luca Milone, Beth Schrope, Lorraine Olivero-Rivera, Nancy Restuccia, Sara Yuen, McKenzie Fisk, William B. Inabnet, Marc Bessler

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

Background: Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status. Methods: A review of 42 RYGB patients with T2DM and <3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved. Results: T2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P ≤.0001; and 85% versus 15%; P = .0006, respectively). Conclusion: Our results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated.

Original languageEnglish (US)
Pages (from-to)249-253
Number of pages5
JournalSurgery for Obesity and Related Diseases
Volume6
Issue number3
DOIs
StatePublished - May 2010
Externally publishedYes

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Gastric Bypass
Recurrence
Body Mass Index
Weights and Measures
Glucose
Bariatric Surgery
Type 2 Diabetes Mellitus
Weight Loss
Fasting
Insulin
Incidence

Keywords

  • Diabetes
  • Gastric bypass
  • Recurrence
  • Remission

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. / Digiorgi, Mary; Rosen, Daniel J.; Choi, Jenny J.; Milone, Luca; Schrope, Beth; Olivero-Rivera, Lorraine; Restuccia, Nancy; Yuen, Sara; Fisk, McKenzie; Inabnet, William B.; Bessler, Marc.

In: Surgery for Obesity and Related Diseases, Vol. 6, No. 3, 05.2010, p. 249-253.

Research output: Contribution to journalArticle

Digiorgi, M, Rosen, DJ, Choi, JJ, Milone, L, Schrope, B, Olivero-Rivera, L, Restuccia, N, Yuen, S, Fisk, M, Inabnet, WB & Bessler, M 2010, 'Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up', Surgery for Obesity and Related Diseases, vol. 6, no. 3, pp. 249-253. https://doi.org/10.1016/j.soard.2009.09.019
Digiorgi, Mary ; Rosen, Daniel J. ; Choi, Jenny J. ; Milone, Luca ; Schrope, Beth ; Olivero-Rivera, Lorraine ; Restuccia, Nancy ; Yuen, Sara ; Fisk, McKenzie ; Inabnet, William B. ; Bessler, Marc. / Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. In: Surgery for Obesity and Related Diseases. 2010 ; Vol. 6, No. 3. pp. 249-253.
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abstract = "Background: Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status. Methods: A review of 42 RYGB patients with T2DM and <3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0{\%} and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved. Results: T2DM had either resolved or improved in all patients (64{\%} and 36{\%}, respectively); 24{\%} (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7{\%} versus 15.4{\%}; P = .002), had a greater weight loss failure rate (63{\%} versus 14{\%}; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92{\%} versus 8{\%}, P ≤.0001; and 85{\%} versus 15{\%}; P = .0006, respectively). Conclusion: Our results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated.",
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T1 - Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up

AU - Digiorgi, Mary

AU - Rosen, Daniel J.

AU - Choi, Jenny J.

AU - Milone, Luca

AU - Schrope, Beth

AU - Olivero-Rivera, Lorraine

AU - Restuccia, Nancy

AU - Yuen, Sara

AU - Fisk, McKenzie

AU - Inabnet, William B.

AU - Bessler, Marc

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N2 - Background: Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status. Methods: A review of 42 RYGB patients with T2DM and <3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved. Results: T2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P ≤.0001; and 85% versus 15%; P = .0006, respectively). Conclusion: Our results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated.

AB - Background: Studies have shown that type 2 diabetes (T2DM) improves or resolves shortly after Roux-en-Y gastric bypass (RYGB). Few data are available on T2DM recurrence or the effect of weight regain on T2DM status. Methods: A review of 42 RYGB patients with T2DM and <3 years of follow-up and laboratory data was performed. Postoperative weight loss and T2DM status was assessed. Recurrence or worsening was defined as hemoglobin A1c >6.0% and fasting glucose >124 mg/dL and/or medication required after remission or improvement. Patients whose T2DM recurred or worsened were compared with those whose did not, and patients whose T2DM improved were compared with those whose T2DM resolved. Results: T2DM had either resolved or improved in all patients (64% and 36%, respectively); 24% (10) recurred or worsened. The patients with recurrence or worsening had had a lower preoperative body mass index than those without recurrence or worsening (47.9 versus 52.9 kg/m2; P = .05), regained a greater percentage of their lost weight (37.7% versus 15.4%; P = .002), had a greater weight loss failure rate (63% versus 14%; P = .03), and had greater postoperative glucose levels (138 versus 102 mg/dL; P = .0002). Patients who required insulin or oral medication before RYGB were more likely to experience improvement rather than resolution (92% versus 8%, P ≤.0001; and 85% versus 15%; P = .0006, respectively). Conclusion: Our results have shown that beyond 3 years after RYGB, the incidence of T2DM recurrence or worsening in patients with initial resolution or improvement was significant. In our patients, a greater likelihood of recurrence or worsening of T2DM was associated with a lower preoperative body mass index. Before widespread acceptance of bariatric surgery as a definitive treatment for those with T2DM can be achieved, additional study of this recurrence phenomenon is indicated.

KW - Diabetes

KW - Gastric bypass

KW - Recurrence

KW - Remission

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