Refractory hyperglycemia after gastric bypass surgery: a novel subtype of type 2 diabetes?

Patients failing to respond to radically effective therapies can provide clues to identify distinct disease subtypes. For example, the recognition of insulin-sensitive and insulin-insensitive patients helped reveal diabetes variants now classified as type 1 and 2. After Roux-en-Y gastric bypass (RYGB), 40–80% of patients with type 2 diabetes (T2DM) experience diabetes remission, and nearly all enjoy improved glycemic control (1–3). Studying absolute nonresponders to RYGB may reveal disease subtypes with distinct pathophysiology. Published series of bariatric surgery, however, usually describe general rates of remitters and nonremitters but do not distinguish between partial responders versus absolute nonresponders