Five-Year Outcomes of Gastric Bypass in Young versus Older Diabetic Adults

Abstract Background Timely metabolic surgery improves glycemic control and reduces cardiovascular risk for patients with type 2 diabetes. Young age is a known predictor of metabolic success but RYGB is often delayed due to the reported vulnerability of young adults. Aims To compare diabetes remission, metabolic outcomes and surgical adverse events in young (18-35 years) and older (>35 years) adults in the first five years following Roux-en-Y gastric bypass (RYGB). Methods We analysed prospective registry data from a single center on young (29.4 years, [standard deviation (SD)=5]) and older (47.7 years, [SD=6.7]) non-insulin-dependent diabetic adults undergoing RYGB. Younger adults were matched one to two to their older counterparts for sex, body mass index, duration of preoperative diabetes and American Society of Anaesthesiologist score. The rate of diabetes remission and adverse events in both groups were compared. Results A total of 78.2% (43/55) of the young and 75.4% (86/114) of the older adults attended the five-year follow-up. Diabetes remission occurred significantly earlier in the young adults group with a hazard ratio of 0.57 [95% confidence interval (CI) 0.23-0.87] and a median time to remission of 12 months [95% CI 3.2-20.8] compared to 24 months [95% CI 10.5-37.4, p=0.031] for older adults. There were no significant differences in loss to follow-up, percent weight change, and all-cause adverse events. Conclusions Diabetes remission occurred earlier and more frequently in young adults within the first 5 years after RYGB. The risk of surgical complications, nutritional deficiency or failure to achieve successful weight loss did not increase in the investigated young adult group.