title: Long-term diabetic response to gastric bypass.
abstract: BACKGROUND
  As obesity and type II diabetes continue to rise, bariatric surgery offers a solution, but few long-term studies are available. The purpose of this study was to evaluate the long-term outcomes of diabetic patients after gastric bypass.
  
  
  METHODS
  This was a retrospective cohort study of all diabetic patients undergoing gastric bypass at our institution, from 1998 to 2012. Patients were compared by postoperative diabetic response to treatment (i.e., response = off oral medication/insulin versus refractory = on oral medication/insulin) and followed at 1-, 3-, 5-, and 10-y intervals. Continuous data were analyzed using Student t-test or Wilcoxon rank-sum test. Multivariable, Cox proportional hazard regression model was performed to compute diabetic cure ratios and 95% confidence intervals.
  
  
  RESULTS
  A total of 2454 bariatric surgeries were performed at our institution during the time period. A total of 707 diabetic patients were selected by Current Procedural Terminology codes for gastric bypass. Mean follow-up was 2.1 y. Incidence of diabetic response was 56% (1 y), 58% (3 y), 60% (5 y), and 44% (10 y). Postoperatively, responsive patients experienced greater percentage of total body weight loss (1 y [P < 0.0001], 3 y [P = 0.0087], and 5 y [P = 0.013]), and less hemoglobin A1c levels (1 y [P = 0.035] and 3 y [P = 0.040]) at follow-up than refractory patients. Multivariable analysis revealed a significant, independent inverse trend in incidence of diabetic cure as both age and body mass index decreased (Ptrend = 0.0019 and <0.0001, respectively). In addition, degenerative joint disease was independently associated with responsive diabetes (cure ratio = 1.6 [95% confidence interval = 1.1-2.2]).
  
  
  CONCLUSIONS
  At follow-up, both groups in our study experienced substantial weight loss; however, a greater loss was observed among the response group. Further research is needed to evaluate methods for optimizing patient care preoperatively and improving patient follow-up.
authors.affiliation: Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia. Electronic address: sd2wf@virginia.edu.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Davies
authors.affiliation: Department of Public Health, Biostatistics Unit, Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.affiliation: Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Guidry
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Rachel I
authors.initials: RI
authors.lastname: Penn
authors.affiliation: Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.affiliation: Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Schirmer
authors.affiliation: Department of General Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D015431:Weight Loss / Q000502:physiology
keywords: Diabetes; Diabetes cure; Gastric bypass; Long-term follow-up