Response to comment on Lent et al. All-Cause and Specific-Cause Mortality Risk After Roux-en-Y Gastric Bypass in Patients With and Without Diabetes. Diabetes Care 2017;40:1379-1385.

We thank Drs. Pontiroli and Zakaria for their thoughtful comments in response to our recent study. Our results indicate that the large, significant overall reduction in mortality risk (when combining patients with and without diabetes) is driven by patients with diabetes. We found that Roux-en-Y gastric bypass (RYGB) patients with diabetes at the time of surgery experienced a survival benefit compared with nonsurgical control subjects with diabetes. The mortality risk in RYGB patients without diabetes was weaker and did not significantly differ from nonsurgical control subjects without diabetes (hazard ratio 0.92 [95% CI 0.64–1.32]). RYGB continues to be the gold standard in bariatric surgery procedures, and our study adds to the strong body of literature documenting the durable benefits of RYGB for patients with obesity and diabetes.