Endocrine Abstracts

Introduction: Various rates were reported regarding diabetes remission and improvement in hyperglycemia in many studies from different populations. Determinants of diabetes remission have not been definitively established so far. In this study, we aimed to evaluate the long-term glycemic status after bariatric surgery in diabetic obese patients followed by Marmara University Endocrinology Outpatient Clinic.

Method: The retrospective study included 233 type 2 diabetic obese patients who underwent either sleeve gastrectomy or gastric bypass between 2011-2021. Preoperative, postoperative sixth month, first year, and second year data were collected from the patient files. In the analysis of the dependent variables, patients who fulfilled whole visits were included. The glycemic status of diabetic patients at postoperative first and second year visits was classified as complete remission, partial remission, recovery, no change, and recurrence in accordance with the criteria of the American Society of Bariatric and Metabolic Surgery, 2022. Remission ratios were calculated for each visit, seperately. Logistic regression was used to analyse the factors affecting diabetes remission for the whole diabetic group.

Results: Postoperative BMI values were significantly lower than the preoperative level (P<0,001), additionally remained similar between the first and the second years. BMI change was found to be similar between gastric bypass and sleeve gastrectomy. Fasting blood glucose and HbA1c levels were significantly lower than the preoperative levels as well (P<0,001). 24.9% (n=58) of the patients were on insulin preoperatively. This ratio was found to be 3.5% (n=6) in the first year and 3.3% (n=4) in the second year. Complete remission rate was 68.0% (n=132) in the first year. In the second year, complete remission and recurrence rates were 59.5% (n=72) and 8.3% (n=10), respectively. Remission rates were similar among the two surgical procedures. To determine the factors affecting remission across the whole sample, a regression model was conducted. Duration of diabetes, preoperative insulin usage, preoperative BMI, and the type of the surgery were included in the model. Preoperative insulin use of patients was associated to diabetes remission outcomes. Patients who were not taking insulin before the surgery were more likely to experience postoperative diabetes remission (OR=7.523, P<0.001, 95%CI 3,075-18.404 for the 1st year; OR=5.096, P=0.002, 95%CI 1.781-14.577 for the 2nd year).

Conclusion: At the postoperative first and second year checkpoints, complete remisson rates were 68.0% and 59.5%, and recurrence rate was 8.3% in the second year. Not using insulin preoperatively made the probability of diabetes remission 5.1 times higher.