Bariatric surgery results in rapid weight loss and resolution of comorbidities such as type 2 diabetes mellitus (T2DM). We aimed to determine whether the type of surgical procedure—vertical sleeve gastrectomy (VSG) versus Roux-en-Y gastric bypass (RYGB)—was associated with sustained remission from T2DM, and to identify other independent predictors of sustained remission. Using the IBM MarketScan database of privately insured patients in the United States, we performed a retrospective cohort study on individuals aged 18-65 y with T2DM on hypoglycemic medication, who underwent either VSG or RYGB from 2010 to 2016. Remission was defined as no refill of antidiabetic medication 180 d after a patient's medication was expected to run out and recurrence as medication refill after at least 180 d of remission. Of 5119 patients in our cohort, 4127 (81%) experienced remission of T2DM, and 816 (19.8%) of the 4127 patients experienced recurrence. Patients who underwent RYGB had a 24% (HR = 1.24, 95% CI: 1.16, 1.32) increased probability of achieving remission compared with VSG. RYGB had a 36% (HR = 0.64, 95% CI: 0.55, 0.74) decreased risk of recurrence compared with VSG. A higher number of diabetic medications at the time of surgery and a higher Charlson index score were associated with decreased probability of remission and an increased risk of recurrence of T2DM. While both procedures are initially effective, RYGB may be better than VSG at providing lasting remission of T2DM. • Both RYGB and VSG are effective surgical weight loss procedures associated with remission of type 2 diabetes. However, our study confirmed previously cited literature suggesting that there is a higher likelihood of remission of T2DM among patients who underwent RYGB compared to patients who underwent VSG. Further, those who underwent VSG had a higher likelihood of recurrence of T2DM as compared to RYGB. • The associations of T2DM remission and recurrence with the number of medications at the time of surgery, age and the higher Charlson Index score suggest that patients with greater disease severity may not have as favorable outcomes as those with less severe disease. • Younger patients (<45 y old), compared to older patients, are more likely to experience remission of T2DM following weight loss surgery. • This provides compelling evidence for primary care providers to encourage their patients with obesity related comorbidities to consider surgical weight loss at a relatively younger age (sooner rather than later). As, early surgical weight loss intervention before the onset of end organ damage and the resultant need for extensive pharmacologic management appears to be the key to improving the remission and decreasing the risk of recurrence in those suffering from T2DM and obesity. [ABSTRACT FROM AUTHOR]