August 14, 2012
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Type 2 diabetes duration associated with disease recurrence after gastric bypass

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Data from a retrospective analysis of patients who underwent Roux-en-Y gastric bypass surgery at the Mayo Clinic Arizona demonstrate that the rate of type 2 diabetes recurrence after the procedure was 21%. Additionally, duration of diabetes was linked to rate of recurrence after surgery.

“Patients with more than 5 years of type 2 diabetes prior to bariatric surgery were 3.8 times more likely to develop a recurrence of type 2 diabetes,” Yessica Ramos, MD, an internal medicine resident at Mayo Clinic Arizona in Scottsdale, said during a press conference.

The researchers identified 138 patients who underwent Roux-en-Y gastric bypass surgery between January 2000 and December 2007. Of these, 72 were included in their analysis and had a minimum of 3 years of continuous follow-up.

Ramos and colleagues aimed to determine the persistence, remission and re-emergence of type 2 diabetes after surgery. Remission was defined as HbA1c <6.5% with no pharmacological treatment; re-emergence was defined as HbA1c ≥6.5%, fasting glucose >7mmol/L or re-initiation of antidiabetic medications, according to the abstract.

Most patients (93%) were white, with a mean age of 49.5 years, and 54% were female. Preoperatively, mean BMI was 45 and mean duration of type 2 diabetes was 4.9 years.

There were 66 patients in remission at a minimum of one time point, and six patients had persistent type 2 diabetes throughout follow-up. Of the 66 patients, 14 had recurrent type 2 diabetes: five patients developed disease 2 years after surgery, three at 3 years after, three at 4 years after and three at 5 years after. Additionally, duration of type 2 diabetes before Roux-en-Y surgery was significantly related to recurrence of disease (P=.0021).

“We ended up finding that one-fifth of the patients will develop diabetes after at least 3 years of follow-up, and up to 5 years of follow-up,” Ramos said.

The most relevant finding was that “the association included a long-standing history of diabetes,” she added.

The OR demonstrating that longer duration of preoperative type 2 diabetes was linked with a higher probability of recurrence was 3.81 after adjusting for time (>5 years vs. <5 years of diabetes). According to Ramos, there was no significant association between preoperative BMI or weight regain and a higher recurrence rate.

“Our conclusions were that the length of diabetes prior to bariatric surgery had a strong relationship to the re-emergence rate of diabetes. Early surgical intervention with type 2 diabetes patients who are obese may improve the durability of their remission of diabetes,” Ramos said.

Ramos Y. Abstract #SAT-161.

Disclosure: The researchers report no relevant financial disclosures.