title: Outcomes in glycemic control in the intermediate follow-up of Roux-en-Y gastric bypass: a Brazilian cohort study.
abstract: BACKGROUND
  It is not widely known whether glycemic control (GC) is sustained after Roux-en-Y gastric bypass (RYGB). The objective of this study was to investigate incidence and remission of type 2 diabetes mellitus (T2DM) among 284 individuals with body mass index (BMI)≥35 kg/m(2) at operation (1998-2011) through 2013.
  
  
  METHODS
  Baseline GC was based on fasting glycemia (FG), hemoglobin A1c (HbA1c), and medication. Incident T2DM, complete (normal GC/HbA1c) and partial (abnormal FG/A1c) remission at the last follow-up visit, and relapse were the outcomes of interest. Kaplan-Meier curves and log-rank tests were used to compare time to improvement according to insulin use and HbA1c levels at baseline. Pre- and postoperative determinants of T2DM improvement were investigated by logistic regression.
  
  
  RESULTS
  Participants were predominantly female (220; 77.2%) with mean age of 39.6 (10.5) years and median BMI of 51.9 (46.1-57.5) kg/m(2) at operation. The mean follow-up time was 5.1 (3.2) years with 67.5% (55.0-78.4) of excess BMI loss (EBL) at the 5(th) year. Normal GC, abnormal FG, and T2DM were observed in 169 (59.5%), 32 (11.2%), and 83 (29.3%) participants at baseline, respectively. The 7 (4.1%) patients with incident T2DM had lower BMI at baseline than those who remained with normal GC (43.6 kg/m(2) [42.0-50.8] versus 52.1 kg/m(2) [46.7-57.7]; P = .01). Complete and partial T2DM remission occurred in 61 (61.3%) and 5 (6.7%) participants, respectively. Baseline HbA1c was associated with a significant difference in the proportion of cases with remission at the 5(th) year of follow-up (P = .016). Age (OR .83; 95% CI .72-.95) and % EBL at the 2(nd) year of follow-up (OR 1.05; 95% CI 1.01-1.09) were independent determinants of T2DM improvement. Relapse occurred in 14 (14.3%) cases.
  
  
  CONCLUSIONS
  We observed a low incidence and impressive improvement rates of T2DM after intermediate follow-up of RYGB.
authors.affiliation: Departamento de Clínica Médica; Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil.
authors.forename: Alline Maria Rezende
authors.initials: AM
authors.lastname: Beleigoli
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil.
authors.forename: Ana Luisa Bittencourt
authors.initials: AL
authors.lastname: Coelho
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Departamento de Cirurgia; Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil.
authors.forename: Marco Túlio Costa
authors.initials: MT
authors.lastname: Diniz
authors.affiliation: Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lages Savassi-Rocha
authors.affiliation: Departamento de Clínica Médica; Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil. Electronic address: mfhsdiniz@yahoo.com.br.
authors.forename: Maria de Fátima Haueisen Sander
authors.initials: Mde F
authors.lastname: Diniz
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Bariatric surgery; Diabetes mellitus; Incidence; Remission; Roux-en-Y gastric bypass