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Remission but risks for patients with diabetes undergoing Roux-en-Y gastric bypass

By Bianca Nogrady
Roux-en-Y gastric bypass (RYGB) achieves diabetes remission within a year for about three-quarters of patients but one in four of these patients will relapse by five years, a Danish study has found.

In the population-based cohort study, published in Diabetologia, researchers looked at the effect of RYGB in 1111 individuals with type 2 diabetes compared with 1074 controls who also had type 2 diabetes but did not undergo gastric bypass.

By one year, 74% of patients treated with RYGB had achieved diabetes remission. Five years after surgery, 73% of those patients who had achieved remission in the first year remained in remission and 27% had relapsed.

The overall prevalence of diabetes remission remained at more than 70% for every six-month period throughout the study, suggesting that some patients achieved remission later.

Patients who had had diabetes for a longer period of time were less likely to achieve remission, as were older individuals and those with higher HbA1c levels or insulin use.

The 90-day mortality rate among those who underwent gastric bypass was less than 0.5%, and 7.5% of patients were readmitted to hospital for any surgical complication in the first 30 days.

The authors also noted improvement in microvascular and macrovascular complications. The incidence of diabetic retinopathy was almost halved, the incidence of hospital-coded diabetic kidney disease was 46% lower and the incidence of diabetic neuropathy was 16% lower in the patients undergoing RYGB compared with controls.

Commenting on the study, endocrinologist Dr John Wentworth, from the Walter and Eliza Hall Institute and Royal Melbourne Hospital, said the remission rates were what would be expected from this procedure and patient population.

‘There is a general feeling that in the longer term, bypass would be more effective for glucose control than a sleeve gastrectomy or a band,’ Dr Wentworth told Endocrinology Today.

However, he stressed that there were also greater risks with this procedure, and pointed to a mortality rate that equated to a death in one in every 200 patients.
Diabetologia 2019: https://doi.org/10.1007/s00125-019-4816-2.