Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: Results of the longitudinal assessment of bariatric surgery study

Jonathan Purnell, Faith Selzer, Abdus S. Wahed, John Pender, Walter Pories, Alfons Pomp, Greg Dakin, James Mitchell, Luis Garcia, Myrlene A. Staten, Carol McCloskey, David E. Cummings, David R. Flum, Anita Courcoulas, Bruce Wolfe

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Abstract

Objective The goals of this study were to determine baseline and postbariatric surgical characteristics associated with type 2 diabetes remission and if, after controlling for differences in weight loss, diabetes remission was greater after Roux-en-Y gastric bypass (RYGBP) than laparoscopic gastric banding (LAGB). RESEARCH DESIGN AND METHODS An observational cohort of obese participants was studied using generalized linear mixed models to examine the associations of bariatric surgery type and diabetes remission rates for up to 3 years. Of 2,458 obese participants enrolled, 1,868 (76%) had complete data to assess diabetes status at both baseline and at least one follow-up visit. Of these, 627 participants (34%) were classified with diabetes: 466 underwent RYGBP and 140 underwent LAGB. RESULTS After 3 years, 68.7% of RYGBP and 30.2% of LAGB participants were in diabetes remission. Baseline factors associated with diabetes remission included a lower weight for LAGB, greater fasting C-peptide, lower leptin-to-fat mass ratio for RYGBP, and a lower hemoglobin A1c without need for insulin for both procedures. After both procedures, greater postsurgical weight loss was associated with remission. However, even after controlling for differences in amount of weight lost, relative diabetes remission rates remained nearly twofold higher after RYGBP than LAGB. CONCLUSIONS Diabetes remission up to 3 years after RYGBP and LAGB was proportionally higher with increasing postsurgical weight loss. However, the nearly twofold greater weight loss-adjusted likelihood of diabetes remission in subjects undergoing RYGBP than LAGB suggests unique mechanisms contributing to improved glucose metabolism beyond weight loss after RYGBP.

Original languageEnglish (US)
Pages (from-to)22-28
Number of pages7
JournalDiabetes Care
Volume39
Issue number7
DOIs
StatePublished - Jul 1 2016

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Bariatric Surgery
Gastric Bypass
Type 2 Diabetes Mellitus
Stomach
Weight Loss
Weights and Measures
C-Peptide
Leptin
Linear Models
Fasting
Hemoglobins
Research Design
Fats
Insulin
Glucose

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding : Results of the longitudinal assessment of bariatric surgery study. / Purnell, Jonathan; Selzer, Faith; Wahed, Abdus S.; Pender, John; Pories, Walter; Pomp, Alfons; Dakin, Greg; Mitchell, James; Garcia, Luis; Staten, Myrlene A.; McCloskey, Carol; Cummings, David E.; Flum, David R.; Courcoulas, Anita; Wolfe, Bruce.

In: Diabetes Care, Vol. 39, No. 7, 01.07.2016, p. 22-28.

Research output: Contribution to journalArticle

Purnell, J, Selzer, F, Wahed, AS, Pender, J, Pories, W, Pomp, A, Dakin, G, Mitchell, J, Garcia, L, Staten, MA, McCloskey, C, Cummings, DE, Flum, DR, Courcoulas, A & Wolfe, B 2016, 'Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: Results of the longitudinal assessment of bariatric surgery study', Diabetes Care, vol. 39, no. 7, pp. 22-28. https://doi.org/10.2337/dc15-2138
Purnell, Jonathan ; Selzer, Faith ; Wahed, Abdus S. ; Pender, John ; Pories, Walter ; Pomp, Alfons ; Dakin, Greg ; Mitchell, James ; Garcia, Luis ; Staten, Myrlene A. ; McCloskey, Carol ; Cummings, David E. ; Flum, David R. ; Courcoulas, Anita ; Wolfe, Bruce. / Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding : Results of the longitudinal assessment of bariatric surgery study. In: Diabetes Care. 2016 ; Vol. 39, No. 7. pp. 22-28.
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AU - Pender, John

AU - Pories, Walter

AU - Pomp, Alfons

AU - Dakin, Greg

AU - Mitchell, James

AU - Garcia, Luis

AU - Staten, Myrlene A.

AU - McCloskey, Carol

AU - Cummings, David E.

AU - Flum, David R.

AU - Courcoulas, Anita

AU - Wolfe, Bruce

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N2 - Objective The goals of this study were to determine baseline and postbariatric surgical characteristics associated with type 2 diabetes remission and if, after controlling for differences in weight loss, diabetes remission was greater after Roux-en-Y gastric bypass (RYGBP) than laparoscopic gastric banding (LAGB). RESEARCH DESIGN AND METHODS An observational cohort of obese participants was studied using generalized linear mixed models to examine the associations of bariatric surgery type and diabetes remission rates for up to 3 years. Of 2,458 obese participants enrolled, 1,868 (76%) had complete data to assess diabetes status at both baseline and at least one follow-up visit. Of these, 627 participants (34%) were classified with diabetes: 466 underwent RYGBP and 140 underwent LAGB. RESULTS After 3 years, 68.7% of RYGBP and 30.2% of LAGB participants were in diabetes remission. Baseline factors associated with diabetes remission included a lower weight for LAGB, greater fasting C-peptide, lower leptin-to-fat mass ratio for RYGBP, and a lower hemoglobin A1c without need for insulin for both procedures. After both procedures, greater postsurgical weight loss was associated with remission. However, even after controlling for differences in amount of weight lost, relative diabetes remission rates remained nearly twofold higher after RYGBP than LAGB. CONCLUSIONS Diabetes remission up to 3 years after RYGBP and LAGB was proportionally higher with increasing postsurgical weight loss. However, the nearly twofold greater weight loss-adjusted likelihood of diabetes remission in subjects undergoing RYGBP than LAGB suggests unique mechanisms contributing to improved glucose metabolism beyond weight loss after RYGBP.

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