Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12 Years Follow-up Study

Roux-en-Y gastric bypass (RYGB) is a recommended treatment for type 2 diabetes mellitus (T2DM) in patients with obesity, with superiority over medical therapy. While diabetes remission is achieved initially in 60-90% of patients following surgery, many may experience relapse of diabetes on the long-term. Data on long-term follow-up of bariatric surgery is scarce. We report this 12-year follow-up study of glycaemic control following RYGB.

Two hundred seventeen patients with obesity (109 diabetic, 108 matched nondiabetic) who underwent RYGB between 2000 and 2008 were identified. Data was recorded prospectively for these patients at baseline and 2 years postoperatively. The long-term data was obtained via direct contact with the patients cross-checked with our hospital/national patients' electronic databases.

The follow-up rate was 88% (initial age 44 ± 9 years, female 79%). The mean (± SD) percentage total weight loss was 28% (± 15%) and 27% (± 17%) at 2 years and 12 years, respectively. Diabetes remission rate was 69% at 2 years, but decreased to 36% at 12 years following surgery. The 12-year incidence of new-onset T2DM in the control group was 4.3%. On univariate analysis, age, preoperative duration of diabetes and use of insulin were associated with less chance of diabetes remission at long-term (p value 0.06, 0.01 and 0.03, respectively). However, on multivariate regression analysis, only the duration of diabetes preoperatively remained significant (p = 0.025).

This study shows a high relapse of diabetes 12-year post-RYGB despite the durability of weight loss. This affects preoperative counselling and indicates a need for a longer follow-up to detect relapse.