Weight regain and type 2 diabetes relapse in the long-term period after bariat ric surgery — who is at risk?

BACKGROUND: Bariatric surgery (BS) is one of the most effective treatment strategies for patients with morbid obesity and type 2 diabetes (T2DM). More than 80% of patients not only lose weight after BS, but also achieve T2DM remission. However, weight regain and T2DM relapse can occur in the long-term (>5–10 yrs). 

AIM: The purpose of the study was to assess the risk factors for T2DM relapse and weight regain ≥5 yrs. after BS.

MATERIALS AND METHODS: The study included 111 patients with obesity and T2DM who underwent BS: sleeve gas trectomy/gastric bypass/SADI/ BPD/DS ≥5 yrs. after BS. All the patients were analyzed according to the two main criteria: weight maintenance and stability of diabetes remission. The T2DM remission criteria were HbA_1c≤6.5% and FPG<7.0 mmol/l for at least 3 months after antidiabetic therapy withdrawal. The weight maintenance criterion was an increase of <10 kg from nadir.

RESULTS: The patients were divided twice into groups with stable weight loss and its maintenance (group 1) vs. weight regain (group 2) and stable T2DM remission (group 3) vs. T2DM relapse (group 4). There were no significant differences be tween Gr.1 and Gr.2 in preoperative characteristics. In Gr. 4 compared to Gr.3 there were statistically significant differences in preoperative HbA_1c (8.70% vs. 7.45%, p<0.001), basal insulin levels (12.70 vs. 28.1 μIU/ml, p<0.001), preoperative C-peptide (3.01 vs. 4.72 ng/ml, p<0.001), T2DM duration (9 vs. 4 yrs., p<0.001), frequency of insulin therapy and multiple hypoglycemic therapy.

CONCLUSION: Risk factors for T2DM relapse included: longer duration of T2DM, higher preoperative HbA1c levels, lower baseline insulin and C-peptide levels, insulin therapy and multiple hypoglycemic therapy. Statistically significant relationship between T2DM relapse and weight regain after BS, as well as their connection with BS type were not found in our study and require further investigation.

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