title: A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass.
abstract: BACKGROUND
  Gastric bypass has profound effects on glycemic control in adults with type 2 diabetes mellitus. The goal of this study was to examine the long-term rates and clinical predictors of diabetes remission and relapse among patients undergoing gastric bypass.
  
  
  METHODS
  We conducted a retrospective cohort study of adults with uncontrolled or medication-controlled type 2 diabetes who underwent gastric bypass from 1995 to 2008 in three integrated health care delivery systems in the USA. Remission and relapse events were defined by diabetes medication use and clinical laboratory measures of glycemic control. We identified 4,434 adults with uncontrolled or medication-controlled type 2 diabetes who had gastric bypass.
  
  
  RESULTS
  Overall, 68.2 % (95 % confidence interval [CI], 66 and 70 %) experienced an initial complete diabetes remission within 5 years after surgery. Among these, 35.1 % (95 % CI, 32 and 38 %) redeveloped diabetes within 5 years. The median duration of remission was 8.3 years. Significant predictors of complete remission and relapse were poor preoperative glycemic control, insulin use, and longer diabetes duration. Weight trajectories after surgery were significantly different for never remitters, relapsers, and durable remitters (p = 0.03).
  
  
  CONCLUSIONS
  Gastric bypass surgery is associated with durable remission of type 2 diabetes in many but not all severely obese diabetic adults, and about one third experience a relapse within 5 years of initial remission. More research is needed to understand the mechanisms of diabetes relapse, the optimal timing of surgery in effecting a durable remission, and the relationship between remission duration and incident microvascular and macrovascular events.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. arterburn.d@ghc.org
authors.forename: David E
authors.initials: DE
authors.lastname: Arterburn
authors.forename: Andy
authors.initials: A
authors.lastname: Bogart
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Sherwood
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Coleman
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Theis
authors.forename: Guilherme M
authors.initials: GM
authors.lastname: Campos
authors.forename: David
authors.initials: D
authors.lastname: McCulloch
authors.forename: Joe
authors.initials: J
authors.lastname: Selby
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000601:surgery; D005215:Fasting; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000601:surgery*; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose