Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study.
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).



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.



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.



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.
Departments of Medicine and Surgery, Oregon Health & Science University, Portland, OR purnellj@ohsu.edu.
Jonathan Q
JQ
Purnell
University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Faith
F
Selzer
University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Abdus S
AS
Wahed
Brody School of Medicine, East Carolina University, Greenville, NC.
John
J
Pender
Brody School of Medicine, East Carolina University, Greenville, NC.
Walter
W
Pories
Weill Cornell Medical College, New York, NY.
Alfons
A
Pomp
Weill Cornell Medical College, New York, NY.
Greg
G
Dakin
Neuropsychiatric Research Institute and University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND.
James
J
Mitchell
Neuropsychiatric Research Institute and University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND.
Luis
L
Garcia
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
Myrlene A
MA
Staten
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Carol
C
McCloskey
Departments of Medicine and Surgery, University of Washington, Seattle, WA.
David E
DE
Cummings
Departments of Medicine and Surgery, University of Washington, Seattle, WA.
David R
DR
Flum
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Anita
A
Courcoulas
Departments of Medicine and Surgery, Oregon Health & Science University, Portland, OR.
Bruce M
BM
Wolfe
D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012074:Remission Induction; D015431:Weight Loss
D002096:C-Peptide; D006442:Glycated Hemoglobin