Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up.
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 >or=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 <or=.0001; and 85% versus 15%; P = .0006, respectively).


CONCLUSIONS
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.
Columbia University Center for Metabolic and Weight Loss Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York 10032, USA. md180@columbia.edu
Mary
M
DiGiorgi
Daniel J
DJ
Rosen
Jenny J
JJ
Choi
Luca
L
Milone
Beth
B
Schrope
Lorraine
L
Olivero-Rivera
Nancy
N
Restuccia
Sara
S
Yuen
McKenzie
M
Fisk
William B
WB
Inabnet
Marc
M
Bessler
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012008:Recurrence
D001786:Blood Glucose