Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study

Jonathan Q Purnell, Faith Selzer, Abdus S Wahed, John Pender, Walter Pories, Alfons Pomp, Greg Dakin, James Mitchell, Luis Garcia, Myrlene A Staten, Carol McCloskey, David E Cummings, David R Flum, Anita Courcoulas, Bruce M Wolfe, Jonathan Q Purnell, Faith Selzer, Abdus S Wahed, John Pender, Walter Pories, Alfons Pomp, Greg Dakin, James Mitchell, Luis Garcia, Myrlene A Staten, Carol McCloskey, David E Cummings, David R Flum, Anita Courcoulas, Bruce M Wolfe

Abstract

Objective: The goals of this study were to determine baseline and postbariatric surgical characteristics associated with type 2 diabetes remission and if, after controlling for differences in weight loss, diabetes remission was greater after Roux-en-Y gastric bypass (RYGBP) than laparoscopic gastric banding (LAGB).

Research design and methods: An observational cohort of obese participants was studied using generalized linear mixed models to examine the associations of bariatric surgery type and diabetes remission rates for up to 3 years. Of 2,458 obese participants enrolled, 1,868 (76%) had complete data to assess diabetes status at both baseline and at least one follow-up visit. Of these, 627 participants (34%) were classified with diabetes: 466 underwent RYGBP and 140 underwent LAGB.

Results: After 3 years, 68.7% of RYGBP and 30.2% of LAGB participants were in diabetes remission. Baseline factors associated with diabetes remission included a lower weight for LAGB, greater fasting C-peptide, lower leptin-to-fat mass ratio for RYGBP, and a lower hemoglobin A1c without need for insulin for both procedures. After both procedures, greater postsurgical weight loss was associated with remission. However, even after controlling for differences in amount of weight lost, relative diabetes remission rates remained nearly twofold higher after RYGBP than LAGB.

Conclusions: Diabetes remission up to 3 years after RYGBP and LAGB was proportionally higher with increasing postsurgical weight loss. However, the nearly twofold greater weight loss-adjusted likelihood of diabetes remission in subjects undergoing RYGBP than LAGB suggests unique mechanisms contributing to improved glucose metabolism beyond weight loss after RYGBP.

© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Figures

Figure 1
Figure 1
Modeled probabilities and 95% CIs for diabetes remission for each postoperative year of follow-up as a function of percent weight loss in participants undergoing LAGB (red lines) and RYGBP (blue lines). aRR estimates and 95% CIs for the association between surgical type (RYGBP vs. LAGB) and diabetes remission are adjusted for percent weight change from baseline and a propensity score consisting of baseline demographic and clinical characteristics associated with type of bariatric surgical procedure. aRR is greater for RYGBP than LAGB at each postoperative year; P ≤ 0.001 for each time point.
Figure 2
Figure 2
Box plots displaying levels of leptin adjusted for fat mass before and yearly for 3 years after undergoing LAGB (left graph, red bars) and RYGBP (right graph, blue bars). Overall test for change from baseline over time accounting for within-participant correlation: P < 0.001 for RYGBP and P = 0.40 for LAGB.

References

    1. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122:248.e5–256.e5
    1. Dixon JB, O’Brien PE, Playfair J, et al. . Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008;299:316–323
    1. Schauer PR, Bhatt DL, Kirwan JP, et al. .; STAMPEDE Investigators . Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med 2014;370:2002–2013
    1. Sjöström L, Lindroos AK, Peltonen M, et al. .; Swedish Obese Subjects Study Scientific Group . Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–2693
    1. Kadera BE, Lum K, Grant J, Pryor AD, Portenier DD, DeMaria EJ. Remission of type 2 diabetes after Roux-en-Y gastric bypass is associated with greater weight loss. Surg Obes Relat Dis 2009;5:305–309
    1. Hamza N, Abbas MH, Darwish A, Shafeek Z, New J, Ammori BJ. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis 2011;7:691–696
    1. Isbell JM, Tamboli RA, Hansen EN, et al. . The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care 2010;33:1438–1442
    1. Laferrère B, Teixeira J, McGinty J, et al. . Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab 2008;93:2479–2485
    1. Bradley D, Conte C, Mittendorfer B, et al. . Gastric bypass and banding equally improve insulin sensitivity and β cell function. J Clin Invest 2012;122:4667–4674
    1. Buse JB, Caprio S, Cefalu WT, et al. . How do we define cure of diabetes? Diabetes Care 2009;32:2133–2135
    1. Courcoulas AP, Christian NJ, Belle SH, et al. .; Longitudinal Assessment of Bariatric Surgery (LABS) Consortium . Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013;310:2416–2425
    1. Widen EM, Strain G, King WC, et al. . Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery. Obes Surg 2014;24:847–854
    1. Still CD, Wood GC, Benotti P, et al. . Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol 2014;2:38–45
    1. Wang GF, Yan YX, Xu N, et al. . Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg 2015;25:199–208
    1. Torquati A, Lutfi R, Abumrad N, Richards WO. Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients? J Gastrointest Surg 2005;9:1112–1116; discussion 1117–1118
    1. Kim MK, Lee HC, Kwon HS, et al. . Visceral obesity is a negative predictor of remission of diabetes 1 year after bariatric surgery. Obesity (Silver Spring) 2011;19:1835–1839
    1. Laferrère B, Heshka S, Wang K, et al. . Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care 2007;30:1709–1716
    1. Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg 2004;239:1–11
    1. Cohen RV, Rubino F, Schiavon C, Cummings DE. Diabetes remission without weight loss after duodenal bypass surgery. Surg Obes Relat Dis 2012;8:e66–e68
    1. Kohli R, Bradley D, Setchell KD, Eagon JC, Abumrad N, Klein S. Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. J Clin Endocrinol Metab 2013;98:E708–E712
    1. Sweeney TE, Morton JM. Metabolic surgery: action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature. Best Pract Res Clin Gastroenterol 2014;28:727–740
    1. Breen DM, Rasmussen BA, Kokorovic A, Wang R, Cheung GW, Lam TK. Jejunal nutrient sensing is required for duodenal-jejunal bypass surgery to rapidly lower glucose concentrations in uncontrolled diabetes. Nat Med 2012;18:950–955
    1. Löfgren P, Andersson I, Adolfsson B, et al. . Long-term prospective and controlled studies demonstrate adipose tissue hypercellularity and relative leptin deficiency in the postobese state. J Clin Endocrinol Metab 2005;90:6207–6213
    1. Korner J, Inabnet W, Conwell IM, et al. . Differential effects of gastric bypass and banding on circulating gut hormone and leptin levels. Obesity (Silver Spring) 2006;14:1553–1561
    1. Sjöström L, Narbro K, Sjöström CD, et al. .; Swedish Obese Subjects Study . Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741–752
    1. Bose M, Machineni S, Oliván B, et al. . Superior appetite hormone profile after equivalent weight loss by gastric bypass compared to gastric banding. Obesity (Silver Spring) 2010;18:1085–1091
    1. Rossetti L, Massillon D, Barzilai N, et al. . Short term effects of leptin on hepatic gluconeogenesis and in vivo insulin action. J Biol Chem 1997;272:27758–27763
    1. Liu L, Karkanias GB, Morales JC, et al. . Intracerebroventricular leptin regulates hepatic but not peripheral glucose fluxes. J Biol Chem 1998;273:31160–31167
    1. Petersen KF, Oral EA, Dufour S, et al. . Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy. J Clin Invest 2002;109:1345–1350
    1. Moon HS, Matarese G, Brennan AM, et al. . Efficacy of metreleptin in obese patients with type 2 diabetes: cellular and molecular pathways underlying leptin tolerance. Diabetes 2011;60:1647–1656
    1. Mittendorfer B, Horowitz JF, DePaoli AM, McCamish MA, Patterson BW, Klein S. Recombinant human leptin treatment does not improve insulin action in obese subjects with type 2 diabetes. Diabetes 2011;60:1474–1477

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner