A decade after randomization in the DIABETCIR trial, Roux-en-Y gastric bypass (RYGB) maintained type 2 diabetes remission in 53% of patients compared with 25% after sleeve gastrectomy and 27% after greater curvature plication — roughly double the rate of the alternative procedures. Among 45 adults with severe obesity and T2D (93% completing 10-year follow-up), predictors of sustained remission regardless of surgical technique included shorter pre-operative diabetes duration, greater weight loss in the first postoperative year, and a robust early rise in GLP-1 secretion at months 1 and 12. Even among those who relapsed — rates of 42–50% across all groups — glucose-lowering medication use declined substantially, suggesting meaningful metabolic improvement short of full remission.
These findings carry significant practical weight. The 10-year horizon is rare in bariatric RCTs, and the 93% retention rate makes this one of the most complete long-term datasets available. The persistent GLP-1 advantage for RYGB aligns with its anatomical rerouting of bile and nutrients — a mechanism sleeve gastrectomy only partially replicates. Critically, the remission-predictor profile (shorter diabetes duration, early weight loss, strong incretin response) gives clinicians a tractable framework for patient selection and timing: operating earlier in the disease course appears to matter as much as surgical choice. The study's core limitation is sample size — 45 patients split three ways yields modest statistical power — so effect estimates should be treated as directional rather than definitive. Still, this is confirmatory and incrementally important evidence that RYGB's metabolic architecture provides durable, mechanism-grounded advantages over simpler restrictive procedures.