Roux-en-Y gastric bypass induced durable diabetes remission in 88% of patients with type 2 diabetes and mild obesity (BMI 30-35 kg/m2) over a median follow-up of 5 years.
Cohort (n=66)
No
Does Roux-en-Y gastric bypass (RYGB) improve diabetes remission and safety in patients with type 2 diabetes and mild obesity (BMI 30-35 kg/m2)?
Roux-en-Y gastric bypass safely and effectively induced durable diabetes remission and reduced predicted cardiovascular risk in patients with type 2 diabetes and mild obesity (BMI 30-35 kg/m2).
OBJECTIVE: Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes in severely obese patients through mechanisms beyond just weight loss, and it may benefit less obese diabetic patients. We determined the long-term impact of RYGB on patients with diabetes and only class I obesity. RESEARCH DESIGN AND METHODS: Sixty-six consecutively selected diabetic patients with BMI 30-35 kg/m(2) underwent RYGB in a tertiary-care hospital and were prospectively studied for up to 6 years (median 5 years range 1-6), with 100% follow-up. Main outcome measures were safety and the percentage of patients experiencing diabetes remission (HbA(1c) <6.5% without diabetes medication). RESULTS: Participants had severe, longstanding diabetes, with disease duration 12.5 ± 7.4 years and HbA(1c) 9.7 ± 1.5%, despite insulin and/or oral diabetes medication usage in everyone. For up to 6 years following RYGB, durable diabetes remission occurred in 88% of cases, with glycemic improvement in 11%. Mean HbA(1c) fell from 9.7 ± 1.5 to 5.9 ± 0.1% (P < 0.001), despite diabetes medication cessation in the majority. Weight loss failed to correlate with several measures of improved glucose homeostasis, consistent with weight-independent antidiabetes mechanisms of RYGB. C-peptide responses to glucose increased substantially, suggesting improved β-cell function. There was no mortality, major surgical morbidity, or excessive weight loss. Hypertension and dyslipidemia also improved, yielding 50-84% reductions in predicted 10-year cardiovascular disease risks of fatal and nonfatal coronary heart disease and stroke. CONCLUSIONS: This is the largest, longest-term study examining RYGB for diabetic patients without severe obesity. RYGB safely and effectively ameliorated diabetes and associated comorbidities, reducing cardiovascular risk, in patients with a BMI of only 30-35 kg/m(2).
Cohen et al. (Tue,) conducted a cohort in Type 2 diabetes and mild obesity (n=66). Roux-en-Y gastric bypass (RYGB) was evaluated on Safety and percentage of patients experiencing diabetes remission (HbA1c <6.5% without diabetes medication). Roux-en-Y gastric bypass induced durable diabetes remission in 88% of patients with type 2 diabetes and mild obesity (BMI 30-35 kg/m2) over a median follow-up of 5 years.