For putting type 2 diabetes into remission, gastric bypass appeared to be the best bariatric surgical option, data from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study indicated.
Among more than 800 patients with obesity and diabetes who had bariatric surgery, 57% of those undergoing Roux-en-Y gastric bypass achieved diabetes remission versus only 22.5% of those who underwent laparoscopic gastric banding over a 7-year period, reported Jonathan Purnell, MD, of Oregon Health & Science University in Portland, and colleagues in the Journal of Clinical Endocrinology & Metabolism.
Even after controlling for amount of weight lost after surgery, four-fold more gastric bypass patients achieved diabetes remission over the 7-year follow-up than gastric banding patients.
Remission was complete in about four-fifths of gastric bypass patients who achieved some degree of remission.
Regardless of bariatric surgery procedures, certain factors were more predictive of achieving diabetes remission after surgery.
For example, younger patients and those with shorter diabetes duration prior to the procedure were more likely to achieve remission. So were those with a greater post-surgical weight loss, as well as those with higher C-peptide levels, higher estimated insulin secretion (HOMA %B), and less insulin use pre-operatively.
Looking specifically at insulin resistance, gastric banding patients were more likely to achieve diabetes remission if they saw a reduction in estimated insulin resistance (HOMA IR) after surgery. On the other hand, an increase in HOMA %B was predictive of remission in gastric bypass patients.
For this analysis, Purnell told MedPage Today his group extended previous 3-year findings out to 7 years after bariatric surgery in order to determine predictors of diabetes remission.
“We had shown that compared to undergoing laparoscopic gastric banding, participant who chose Roux-en-Y gastric bypass were nearly twice as likely to achieve diabetes remission, even accounting for differences in weight loss,” he pointed out. “In the present study, we tested the durability of this finding during longer follow-up.”
Purnell and colleagues analyzed data on 827 adult participants from ten U.S. centers who underwent bariatric surgery between 2006 and 2009 and had diabetes at baseline. Roux-en-Y bypass was performed in 645; the remainder underwent lap banding.
Full diabetes remission was defined as an HbA1c less than 5.7% or a fasting glucose under 100 mg/dL in the absence of diabetes pharmacologic therapy. Partial diabetes remission was defined as an HbA1c between 5.7 to 6.5% or a fasting glucose between 100-125 mg/dL in the absence of diabetes pharmacologic therapy.
“Diabetes remission after Roux-en-Y gastric bypass is highly durable long-term,” Purnell said, despite a slight decline in the percentage of patients remaining in remission over time. Remission rates peaked about two to three years after both types of procedures and then fell off.
Overall, he said, “we find evidence of weight-loss independent benefits on glucose metabolism in those that undergo RYGB, which if better understood could lead to new or novel treatments for diabetes.”
“Consistent with similar studies, we find that a patient’s chances for achieving remission in their diabetes is greatest when they undergo surgery soon after diagnosis is established and when they need fewer medications,” Purnell suggested, pointing out that this finding is particularly clinically relevant as its “in contrast to current practice, which is often to wait until medical treatment has failed and/or they need multiple medications or insulin to maintain control.”
But playing that waiting game will likely lessen the patient’s chances that will have the best outcome of diabetes remission, he concluded.
The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.
Purnell reported a relationship with Novo Nordisk. One co-author reported a relationship with Allurion. No other disclosures were reported.