Type 2 diabetes remission in gastric bypass patients is NOT permanent in many patients.  See this recent paper:

Br J Surg. 2011 Oct 21. doi: 10.1002/bjs.7704. [Epub ahead of print]

Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders.

Pournaras DJ, Aasheim ET, Søvik TT, Andrews R, Mahon D, Welbourn R, Olbers T, le Roux CW.

Source

Imperial Weight Centre, Imperial College London, Charing Cross Hospital, London, UK; Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, UK.

Abstract

BACKGROUND:

The American Diabetes Association recently defined remission of type II diabetes as a return to normal measures of glucose metabolism (haemoglobin (Hb) A1c below 6 per cent, fasting glucose less than 5·6 mmol/l) at least 1 year after bariatric surgery without hypoglycaemic medication. A previously used common definition was: being off diabetes medication with normal fasting blood glucose level or HbA1c below 6 per cent. This study evaluated the proportion of patients achieving complete remission of type II diabetes following bariatric surgery according to these definitions.

METHODS:

This was a retrospective review of data collected prospectively in three bariatric centres on patients undergoing gastric bypass, sleeve gastrectomy and gastric banding.

RESULTS:

Some 1006 patients underwent surgery, of whom 209 had type II diabetes. Median follow-up was 23 (range 12-75) months. HbA1c was reduced after operation in all three surgical groups (P < 0·001). A total of 72 (34·4 per cent) of 209 patients had complete remission of diabetes, according to the new definition; the remission rates were 40·6 per cent (65 of 160) after gastric bypass, 26 per cent (5 of 19) after sleeve gastrectomy and 7 per cent (2 of 30) after gastric banding (P < 0·001 between groups). The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40·6 versus 57·5 per cent; P = 0·003).

CONCLUSION:

Expectations of patients and clinicians may have to be adjusted as regards remission of type II diabetes after bariatric surgery. Focusing on improved glycaemic control rather than remission may better reflect the benefit of this type of surgery and facilitate improved glycaemic control after surgery. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.


This study did not address the success rate with the DS, AND was not even that long-term.  However, numerous studies have demonstrated (albeit not by these criteria) that the DS works far far better.

Obes Facts. 2011;4 Suppl 1:18-23. Epub 2011 Mar 31.

Biliopancreatic Diversion with Duodenal Switch in Patients with Type 2 Diabetes mellitus: Is the Chance of Complete Remission Dependent on Therapy and Duration of Insulin Treatment?

Cho EY, Kemmet O, Frenken M.

Source

Department of Surgery, St. Josef Krankenhaus Monheim, Germany.

Abstract

Background: Rapid resolution of type 2 diabetes mellitus (T2DM) is a common feature after intestinal bypass surgery bypassing the duodenum and parts of the jejunum. However, the parameters determining the individual chance of remission are imprecisely defined.

Methods: Biliopancreatic diversion with duodenal switch and sleeve gastrectomy (BPD-DS) was performed in n = 86 patients with T2DM (mean age 50 years, range 26-68, 51 females; BMI 47 kg/m(2), range 26-71). The patients were retrospectively divided into 4 groups according to the treatment modality and the duration of insulin treatment preoperatively: n = 18 patients were treated with oral antidiabetic drugs only (group 1); n = 32, n = 24, and n = 12 patients were treated with insulin for less than 5 years, for 5-10 years, and for more than 10 years (groups 2, 3, and 4), respectively.

Results: At discharge from hospital, all patients of groups 1 and 2 were free of insulin usage, 30% and 75% of the patients of groups 3 and 4 used up to 48 units of insulin per day (mean 24, n = 16). After 1 year, only 4 patients of group 4 permanently required small amounts of insulin (mean 17 units per day) to keep blood glucose below 200 mg/dl. These 4 patients had been using insulin preoperatively for 13, 15, 22, and 25 years. In 3 of these 4 patients, fasting C-peptide was measured and found to be low  ( < 1.2 ng/ml). The rate of complete remission of diabetes for the whole study population was 91%.

Conclusion: BPD-DS reliably causes rapid and complete remission of T2DM in all patients on oral antidiabetic drugs and in patients with insulin treatment for less than 5 years. In patients with insulin treatment longer than 5 or 10 years, complete remission rates decline to 88 and 66%, respectively. A low C-peptide preoperatively might be a specific adverse prognostic parameter for the chance of diabetes remission.

[ETA: it is those pesky "greater than" and "less than" symbol that screw things up - I put spaces around the one in the text above, and hope that will fix it.]

Oh crap - OH's lousy message board "functionality" strikes again - my post had 3 studies in it, and somehow, the title of the second ended up with the abstract and results of the third, and I lost the explanatory text in between.  Let's see if I can fix it.

The long term results for the DS, although using different criteria to define a cure:

Obes Surg. 2007 Nov;17(11):1421-30.

Duodenal switch: long-term results.

Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S.

Source

Department of Surgery, Laval University, Laval Hospital, Québec, Canada. picard.marceau@chg.ulaval.ca

Abstract

BACKGROUND:

This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992 to 2005.

METHODS:

Within the last 2 years, follow-up of these patients, including clinical biochemistry evaluation by us or by their local physician is 97%.

RESULTS:

Survival rate was 92% after DS. The risk of death (Excess Hazard Ratio (EHR)) was 1.2, almost that of the general population. After a mean of 7.3 years (range 2-15), 92% of patients with an initial BMI < or = 50 kg/m2 obtained a BMI < 35 and 83% of those with an initial BMI > 50 obtained a BMI < 40. Diabetes was cured (i.e. medication was discontinued) in 92% and medication decreased in the others. The use of the CPAP apparatus was discontinued in 90%, medication for asthma was decreased in 88%, and the prevalence of a cardiac risk index > 5 was decreased by 86%. Patients' satisfaction in regard to weight loss was graded 3.6 on a basis of 5, and 95% of patients were satisfied with the overall results. Operative mortality was 1% which is comparable with gastric bypass surgery. The need for revision for malnutrition was rare (0.7%) and total reversal was exceptional (0.2%). Failure to lose > 25% of initial excess weight was 1.3%. Revision for failure to lose sufficient weight was needed in only 1.5%. Severe anemia, deficiency in vitamins or bone damage were exceptional, easily treatable, preventable and no permanent damage was documented.

CONCLUSION:

In the long-term, DS was very efficient in terms of cure rate for morbid obesity and its comorbidities. In terms of risk/benefit, DS was very sucessful with an appropriate system of follow-up.

WHAT MOST folks refuse to accept is that even with perfect control of blood sugars they are still diabetic, and must monitor the glucose levels and report themselves as diabetics to care givers,  the coronary damage from diabetes is done and is permanent long before the patient even knows they are diabetic.  you must maintain vigilance. even though i have perfect a1c , it is a average , or mean, so there is some very highs and some lows, I take januvia daily to even those out. and a blood thinner at bed time to avoid sleeping spikes.  I I go for perfection.