TY - JOUR
T1 - Diabetes Remission Status during Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study
AU - Purnell, Jonathan Q.
AU - Dewey, Elizabeth N.
AU - Laferrère, Blandine
AU - Selzer, Faith
AU - Flum, David R.
AU - Mitchell, James E.
AU - Pomp, Alfons
AU - Pories, Walter J.
AU - Inge, Thomas
AU - Courcoulas, Anita
AU - Wolfe, Bruce
N1 - Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Context: Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery. Objective: To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB). Design: An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB. Setting: Ten US hospitals. Participants: A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit. Interventions: Roux-en-Y gastric bypass or LAGB. Main Outcome Measures: Diabetes rates and associations of patient characteristics with remission status. Results: Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB. Conclusions: Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB. Trial Registration clinicaltrials.gov Identifier: NCT00465829.
AB - Context: Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery. Objective: To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB). Design: An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB. Setting: Ten US hospitals. Participants: A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit. Interventions: Roux-en-Y gastric bypass or LAGB. Main Outcome Measures: Diabetes rates and associations of patient characteristics with remission status. Results: Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB. Conclusions: Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB. Trial Registration clinicaltrials.gov Identifier: NCT00465829.
KW - beta-cell function
KW - diabetes
KW - gastric bypass
KW - laparoscopic gastric band
KW - remission
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U2 - 10.1210/clinem/dgaa849
DO - 10.1210/clinem/dgaa849
M3 - Article
C2 - 33270130
AN - SCOPUS:85102908910
VL - 106
SP - 774
EP - 788
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 3
ER -