Gastric Bypass Boosts T2D Remission, Even With Weight Regain


Roux-en-Y gastric bypass (RYGB) surgery produced high rates of type 2 diabetes (T2D) remission 5 years after the operation, even after patients regained a significant amount of weight. In those who regained weight following surgery, diabetes was five times more likely to return for those who underwent sleeve gastrectomy (SG) vs RYGB.


Retrospective review of patients with a baseline body mass index (BMI) ≥ 35 and preoperative diagnosis of T2D who underwent successful primary RYGB (n = 224) or SG (n = 46).


  • At follow-up (average 8.1 and 7.3 years for RYGB and SG, respectively), the overall rate of continued T2D remission was significantly higher in the RYGB group (75%, n = 168) than in the SG group (34.8%, n = 16), P < .001.
  • In multivariable analysis controlled for age, sex, preoperative duration of T2D, insulin use, A1c, fasting glucose, BMI, and weight recurrence percentage, the odds of T2D recurrence were 5.5 times higher after SG than after RYGB.
  • Among the RYGB patients, n = 55, n = 82, n = 57, and n = 30 regained < 25%, 25-49.9%, 50-74.9%, and ≥ 75% of their weight, respectively, while the respective proportions maintaining T2D remission were 85.5%, 81.7%, 63.2%, and 60%.
  • In multivariable analysis, weight recurrence was not independently associated with increased T2D recurrence, but factors that were included were baseline insulin dependence (odds ratio [OR], 2.63; 95% CI, 1.17-5.91), higher preoperative A1c (OR, 1.50; 95% CI, 1.10-2.06), and longer preoperative duration of T2D (OR, 1.06; 95% CI, 1.02-1.10).


“Despite weight recurrence not being an independent factor associated with T2D recurrence, its importance cannot be overlooked. Some patients with complete weight recurrence after RYGB maintained significant continued diabetes remission, further supporting a potential role of the proximal small intestines in metabolic control that is less dependent on the weight loss achieved through gastric restriction.”


The study was conducted by Omar M. Ghanem, MD, of the Department of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, Minnesota, and colleagues and published online on February 13, 2024, in the Journal of the American College of Surgeons.


Retrospective design.


The author had no conflicts of interest to disclose.

Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. She is on X (formerly known as Twitter) @MiriamETucker.

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