TOPLINE

In a retrospective study of patients with obesity and type 2 diabetes (T2D), about 60% were in diabetes remission 5 years after bariatric surgery, with remission being more common among those with a shorter diabetes history and better blood sugar control before surgery. Although about 80% experienced remission at some point, just over 1 in 5 subsequently experienced relapse, most often in years 4 and 5, and diabetes history and preoperative blood sugar control were linked to relapse risk. 

METHODOLOGY

• Patients with obesity are at a high risk for T2D. Bariatric surgery is among the most effective treatments for obesity and can improve T2D, sometimes leading to remission. However, how long remission lasts and which patients are most likely to experience relapse remain less clear.
• Researchers conducted a retrospective study of patients with obesity and T2D who underwent bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) between January 2006 and December 2020. The goal was to assess how long diabetes remission lasts and what helps predict both sustained remission and relapse.
• A total of 151 participants (mean age at surgery, 49 years; 61.6% women) with at least 5 years of follow-up were included; the mean follow-up duration was 81.7 months.
• Remission was defined according to American Diabetes Association criteria as partial (an A1c level < 6.5% and a fasting glucose level of 100-125 mg/dL), complete (an A1c level < 6.0% and a fasting glucose level < 100 mg/dL), or prolonged (complete remission lasting more than 5 years). Partial and complete remission had to be maintained for at least 1 year without diabetes medication.
• Primary outcomes were sustained T2D remission, meaning any remission (partial or complete) still present at 5 years, and glycemic relapse during follow-up.

TAKEAWAY

• Of the 151 patients, 120 (79.5%) achieved diabetes remission at some point during follow-up; at 5 years, 91 (60.3%) patients were in remission, including 60 with complete remission and 31 with partial remission.
• A longer diabetes duration and higher A1c levels before surgery were each associated with lower odds of remission at 5 years after adjustment. Each additional month since T2D diagnosis was associated with 2% lower odds of remission (adjusted odds ratio [aOR], 0.980; P < .001), and each 1-percentage-point increase in the A1c level was associated with about 33% lower odds of remission (aOR, 0.671; P = .002).
• Of the 120 patients who experienced remission, 27 (22.5%) subsequently had a relapse, and two thirds of the relapses (18 of 27) occurred in the fourth and fifth years after surgery.
• A longer diabetes duration (adjusted hazard ratio [aHR], 1.015 per month; P = .001) and higher pre-surgery A1c levels (aHR, 1.283 per 1-percentage point increase; P = .015) were associated with a higher risk for relapse. Greater excess weight loss at 1 year was associated with a lower risk for relapse (aHR, 0.754 per 10-percentage-point increase; P = .005).

IN PRACTICE

"These findings highlight the importance of appropriate patient selection, early postoperative weight-loss response, and continued metabolic follow-up after surgery," the authors wrote.

SOURCE

The study was led by Juan Alberto Sanchez Forero, Department of General and Digestive Surgery, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain. It was published online in Obesity Surgery.

LIMITATIONS

The study was retrospective and conducted at a single center. The sample size was relatively small, and only patients with at least 5 years of follow-up were included, which may have introduced selection bias. The analysis of patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass introduced heterogeneity and may have affected procedure-specific comparisons. 

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.