Adults who have obesity and Type 2 diabetes are much more likely to see their diabetes stay in remission if they undergo gastric bypass surgery rather than sleeve gastrectomy, even after regaining weight, according to a study published in the Journal of the American College of Surgeons (JACS).
For the study, researchers investigated whether diabetes returned when patients regained their weight after bariatric surgery. The review was based on data from 224 patients who underwent gastric bypass surgery and 46 control subjects who underwent sleeve gastrectomy at Mayo Clinic between 2008 and 2017. All patients involved in the analysis had obesity and had been diagnosed with Type 2 diabetes before they underwent weight loss surgery. Each patient was followed for at least five years after the operation. Diabetes remission rates were then grouped into four weight relapse categories and compared. The aim was to see if weight gain led to diabetes recurrence.
Among key findings of the study
- Overall, 75% of gastric bypass patients saw their diabetes stay in remission, compared with only 34.8% of patients in the sleeve gastrectomy group.
- After adjusting for patient and weight-related factors, the odds of diabetes returning over the 5-year follow-up period were 5.5 times greater in the sleeve gastrectomy group compared to the gastric bypass group.
- In a subgroup analysis of gastric bypass patients, diabetes remission rates were stratified into four weight regain categories. Over half of the patients in all four categories (patients who lost weight after surgery and regained 25%, 25% to 50%, 50% to 75%, and more than 75% of the weight they initially lost from having surgery) kept their diabetes in remission.
- Among patients who regained 100% or more of their weight after gastric bypass surgery, about 60% kept their diabetes in remission five years after the operation, compared to zero in the gastric sleeve group.
- Insulin use, higher preoperative A1c (which measures average blood sugar levels), and longer preoperative duration of diabetes were associated with diabetes recurrence, whereas weight regain was not.
