What is the clinical evidence from this study?

Study design: Cohort. Population: Morbid obesity with Type-2 Diabetes Mellitus and albuminuria (n=122). Intervention: Roux-en-Y gastric bypass (RYGB) vs. Lifestyle intervention (diet and exercise). Primary outcome: Albuminuria remission (Adjusted OR 3.27, 95% CI 1.23-8.67, p=0.017).

July 18, 2026International Journal of General Medicine0 citationsOpen Access

Effect of Roux-En-Y Gastric Bypass on Albuminuria in Morbidly Obese Patients with Type-2 Diabetes Mellitus: A Prospective Non-Randomized Controlled Study with 15-Month Follow-Up

ASAhmed Salman MSMohamed Abdalla Salman ATAhmed E Taha

Key Result

Roux-en-Y gastric bypass significantly increased the rate of albuminuria remission compared to lifestyle intervention (57.8% vs 24.1%; adjusted OR 3.27) in morbidly obese patients with type-2 diabetes.

Key Points

This study aimed to evaluate the effect of Roux-en-Y gastric bypass on albuminuria in morbidly obese patients with type-2 diabetes.
Prospective non-randomized controlled study with two groups: RYGB (n=64) and Control (n=58) receiving lifestyle measures.
Albuminuria measured by spot urine albumin-to-creatinine ratio on a first-morning urine sample.
Follow-up period was 15 months to assess remission and improvement of albuminuria.
RYGB group achieved a significantly higher albuminuria remission rate of 57.8% compared to 24.1% in the Control group (p<0.001).
Lower baseline triglyceride and LDL-cholesterol levels were associated with albuminuria remission (p=0.012 and p=0.040, respectively).
RYGB was the only independent predictor of albuminuria remission with an adjusted odds ratio of 3.27 (95% CI 1.23–8.67; p=0.017).

Study Design

Type

Cohort (n=122)

Blinding

Open-label

Randomization

None

Multicenter

Structured PICO

Does Roux-en-Y gastric bypass improve albuminuria in morbidly obese patients with type-2 diabetes mellitus?

Population

122 morbidly obese adults (aged 18-60 years) with type-2 diabetes and albuminuria, followed for 15 months.

Intervention

Roux-en-Y gastric bypass (RYGB)

Comparator

Conservative (lifestyle) measures only

Outcome

Remission and improvement of albuminuria (determined from spot urine albumin-to-creatinine ratio on a first-morning urine sample) at 15 monthssurrogate

In morbidly obese patients with T2DM, Roux-en-Y gastric bypass was associated with a significantly higher rate of albuminuria remission compared to lifestyle intervention at 15 months.

Main Result

Odds Ratio: 3.27 (95% CI 1.23–8.67)

Absolute Event Rate: 57.8% vs 24.1%

p-value: p=0.017

Limitations

Allocation was not randomized but based on patient preference, introducing potential selection bias and confounding by indication.
Baseline imbalances between groups in age, BMI, HOMA-IR, LDL-cholesterol, and ALT.
Urinary albumin was determined from a single first-morning specimen at each time point, which may misclassify albuminuria status.
Small sample size marginally below the calculated minimum of 66 per group.
Concomitant use of glucose-lowering agents with known renal effects and the degree of ARB up-titration were not fully accounted for in the analysis.
Adipokine levels were not measured.
non-randomized cohort
baseline differences between groups

Abstract

Background: Obesity increases the risk of chronic kidney disease and has been linked to proteinuria and albuminuria. Roux-en-Y gastric bypass (RYGB) plays a significant role in the treatment of obesity and type-2 diabetes mellitus (T2DM). This study aimed to examine the effect of RYGB on albuminuria in patients with morbid obesity and T2DM. Methods: This prospective, non-randomized, controlled study included two groups of patients with morbid obesity and T2DM; allocation was by patient preference rather than randomization. The RYGB Group (n = 64) underwent RYGB, and the Control Group (n = 58) received conservative (lifestyle) measures only. Micro- and macroalbuminuria were determined from spot urine albumin-to-creatinine ratio (uACR) on a first-morning urine sample. Patients were monitored for 15 months for remission and improvement of albuminuria. Groups were compared using the independent-sample t -test, Mann–Whitney test, or chi-square test as appropriate, and multivariable logistic regression was used to adjust for baseline differences. Results: The groups differed significantly at baseline in age, body mass index (BMI), HOMA-IR index, LDL-cholesterol, and ALT. RYGB achieved a significantly (p < 0.001) greater rate of albuminuria remission (57.8%) than diet control (24.1%). None of the baseline characteristics were associated with albuminuria remission except lower baseline triglyceride (p = 0.012) and LDL-cholesterol (p = 0.040) levels. Albuminuria remission was associated with significantly greater weight loss (p = 0.003) and lower BMI (p = 0.019), fasting plasma insulin (p = 0.014), HOMA-IR (p = 0.011), total cholesterol (p = 0.026), LDL-cholesterol (p = 0.001), ALT (p = 0.033), and AST (p = 0.009). After adjustment for baseline differences, RYGB remained the only independent predictor of albuminuria remission (adjusted odds ratio 3.27, 95% CI 1.23– 8.67; p = 0.017). Conclusion: In this non-randomized cohort, RYGB was associated with a significantly higher rate of albuminuria remission than lifestyle intervention over 15 months. Remission was associated with greater weight loss, lower plasma insulin, and improved insulin sensitivity rather than with diabetes remission itself. Randomized or better-adjusted prospective studies are warranted to confirm these findings. Keywords: Roux-en-Y gastric bypass, type-2 diabetes, bariatric surgery, morbid obesity, diabetic nephropathy, albuminuria

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