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- Title
Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study.
- Authors
Purnell, Jonathan Q.; Dewey, Elizabeth N.; Laferrère, Blandine; Selzer, Faith; Flum, David R.; Mitchell, James E.; Pomp, Alfons; Pories, Walter J.; Inge, Thomas; Courcoulas, Anita; Wolfe, Bruce M.
- Abstract
<bold>Context: </bold>Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery.<bold>Objective: </bold>To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB).<bold>Design: </bold>An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB.<bold>Setting: </bold>Ten US hospitals.<bold>Participants: </bold>A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit.<bold>Interventions: </bold>Roux-en-Y gastric bypass or LAGB.<bold>Main Outcome Measures: </bold>Diabetes rates and associations of patient characteristics with remission status.<bold>Results: </bold>Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB.<bold>Conclusions: </bold>Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB.Trial Registration clinicaltrials.gov Identifier: NCT00465829.
- Subjects
UNITED States; ASPARTATE aminotransferase; ALANINE aminotransferase; BARIATRIC surgery; DIABETES; GASTRIC banding; TYPE 2 diabetes; DIABETES complications; RESEARCH; RESEARCH methodology; MORBID obesity; MEDICAL cooperation; EVALUATION research; TREATMENT effectiveness; COMPARATIVE studies; RESEARCH funding; LONGITUDINAL method; DISEASE remission; DISEASE complications
- Publication
Journal of Clinical Endocrinology & Metabolism, 2021, Vol 106, Issue 3, p774
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/clinem/dgaa849