Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007–2015: A registry-based cohort study

Autoři: Anders Jans aff001;  Ingmar Näslund aff001;  Johan Ottosson aff001;  Eva Szabo aff001;  Erik Näslund aff002;  Erik Stenberg aff001
Působiště autorů: Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden aff001;  Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden aff002
Vyšlo v časopise: Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007–2015: A registry-based cohort study. PLoS Med 16(11): e1002985. doi:10.1371/journal.pmed.1002985
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pmed.1002985



Although bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery.

Methods and findings

We conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79–0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75–0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85–0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20–0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93–0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97–0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29–1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05–1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up.


In this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.

Klíčová slova:

Insulin – Drug therapy – Surgical and invasive medical procedures – Digestive system procedures – Sweden


1. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67. doi: 10.1016/S0140-6736(10)62037-5 21295846

2. NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–96. doi: 10.1016/S0140-6736(16)30054-X 27115820

3. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81. doi: 10.1016/S0140-6736(14)60460-8 24880830

4. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Suppl 1):S81–90.

5. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–49. doi: 10.1016/j.diabres.2013.11.002 24630390

6. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34. doi: 10.1111/joim.12012 23163728

7. Sjostrom L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden A, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304. doi: 10.1001/jama.2014.5988 24915261

8. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85. doi: 10.1056/NEJMoa1200111 22449317

9. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51. doi: 10.1056/NEJMoa1600869 28199805

10. Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77. doi: 10.2337/dc16-0236 27222544

11. Backman O, Bruze G, Naslund I, Ottosson J, Marsk R, Neovius M, et al. Gastric bypass surgery reduces de novo cases of type 2 diabetes to population levels: a nationwide cohort study from Sweden. Ann Surg. 2019;269(5):895–902. doi: 10.1097/SLA.0000000000002983 30102631

12. Arterburn DE, Bogart A, Sherwood NE, Sidney S, Coleman KJ, Haneuse S, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23(1):93–102. doi: 10.1007/s11695-012-0802-1 23161525

13. Panunzi S, Carlsson L, De Gaetano A, Peltonen M, Rice T, Sjostrom L, et al. Determinants of diabetes remission and glycemic control after bariatric surgery. Diabetes Care. 2016;39(1):166–74. doi: 10.2337/dc15-0575 26628418

14. Aung L, Lee WJ, Chen SC, Ser KH, Wu CC, Chong K, et al. Bariatric surgery for patients with early-onset vs late-onset type 2 diabetes. JAMA Surg. 2016;151(9):798–805. doi: 10.1001/jamasurg.2016.1130 27248572

15. Blackstone R, Bunt JC, Cortes MC, Sugerman HJ. Type 2 diabetes after gastric bypass: remission in five models using HbA1c, fasting blood glucose, and medication status. Surg Obes Relat Dis. 2012;8(5):548–55. doi: 10.1016/j.soard.2012.05.005 22721581

16. Brethauer SA, Aminian A, Romero-Talamas H, Batayyah E, Mackey J, Kennedy L, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36. doi: 10.1097/SLA.0b013e3182a5034b 24018646

17. Hedenbro JL, Naslund E, Boman L, Lundegardh G, Bylund A, Ekelund M, et al. Formation of the Scandinavian Obesity Surgery Registry, SOReg. Obes Surg. 2015;25(10):1893–900. doi: 10.1007/s11695-015-1619-5 25703826

18. Olbers T, Lonroth H, Fagevik-Olsen M, Lundell L. Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome. Obes Surg. 2003;13(3):364–70. doi: 10.1381/096089203765887679 12841895

19. Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016;40(9):2065–83. doi: 10.1007/s00268-016-3492-3 26943657

20. Brethauer SA, Kim J, El Chaar M, Papasavas P, Eisenberg D, Rogers A, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506. doi: 10.1016/j.soard.2015.02.003 26093765

21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. doi: 10.1097/01.sla.0000133083.54934.ae 15273542

22. Koliaki C, Liatis S, le Roux CW, Kokkinos A. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017;17(1):50. doi: 10.1186/s12902-017-0202-6 28797248

23. Huang X, Liu T, Zhong M, Cheng Y, Hu S, Liu S. Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: a meta-analysis, meta-regression, and systematic review. Surg Obes Relat Dis. 2018;14(12):1822–31. doi: 10.1016/j.soard.2018.08.027 30385071

24. Purnell JQ, Johnson GS, Wahed AS, Dalla Man C, Piccinini F, Cobelli C, et al. Prospective evaluation of insulin and incretin dynamics in obese adults with and without diabetes for 2 years after Roux-en-Y gastric bypass. Diabetologia. 2018;61(5):1142–54. doi: 10.1007/s00125-018-4553-y 29428999

25. Bradley D, Conte C, Mittendorfer B, Eagon JC, Varela JE, Fabbrini E, et al. Gastric bypass and banding equally improve insulin sensitivity and beta cell function. J Clin Invest. 2012;122(12):4667–74. doi: 10.1172/JCI64895 23187122

26. Jackness C, Karmally W, Febres G, Conwell IM, Ahmed L, Bessler M, et al. Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and beta-cell function in type 2 diabetic patients. Diabetes. 2013;62(9):3027–32. doi: 10.2337/db12-1762 23610060

27. Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39(6):893–901. doi: 10.2337/dc16-0145 27222547

28. Chang WW, Hawkins DN, Brockmeyer JR, Faler BJ, Hoppe SW, Prasad BM. Factors influencing long-term weight loss after bariatric surgery. Surg Obes Relat Dis. 2019;15(3):456–61. doi: 10.1016/j.soard.2018.12.033 30713118

29. Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S57–63.

30. Seyssel K, Suter M, Pattou F, Caiazzo R, Verkindt H, Raverdy V, et al. A Predictive model of weight loss after Roux-en-Y gastric bypass up to 5 years after surgery: a useful tool to select and manage candidates to bariatric surgery. Obes Surg. 2018;28(11):3393–9. doi: 10.1007/s11695-018-3355-0 29923140

31. Peterli R, Wolnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250(2):234–41. doi: 10.1097/SLA.0b013e3181ae32e3 19638921

32. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193–203. doi: 10.2337/dc08-9025 18945920

33. Higa K, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25. doi: 10.1016/j.soard.2010.10.019 21333610

Interné lekárstvo

Článok vyšiel v časopise

PLOS Medicine

2019 Číslo 11

Najčítanejšie v tomto čísle

Tejto téme sa ďalej venujú…

Zabudnuté heslo

Nemáte účet?  Registrujte sa

Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.


Nemáte účet?  Registrujte sa