Authors Haseem Raja Bedfordshire Hospitals NHS Foundation Trust Saarah Ebrahim Bedfordshire Hospitals NHS Foundation Trust Ravikrishna Mamidanna Bedfordshire Hospitals NHS Foundation Trust Krashna Patel Bedfordshire Hospitals NHS Foundation Trust Alan Askari Bedfordshire Hospitals NHS Trust Chanpreet Arhi Bedfordshire Hospitals NHS Foundation Trust Aruna Munasinghe Bedfordshire Hospitals NHS Foundation Trust Farhan Rashid Bedfordshire Hospitals NHS Foundation Trust Omer Al-Taan Bedfordshire Hospitals NHS Foundation Trust Periyathambi Jambulingam Bedfordshire Hospitals NHS Foundation Trust Douglas Whitelaw Bedfordshire Hospitals NHS Foundation Trust Vigyan Jain Bedfordshire Hospitals NHS Foundation Trust Anjali Zalin Bedfordshire Hospitals NHS Foundation Trust Tariq Rehman Bedfordshire Hospitals NHS Foundation Trust MD Tanveer Asil Bedfordshire Hospitals NHS Foundation Trust DOI: https://doi.org/10.15277/bjd.2023.409 Keywords: diabetes mellitus, obesity, bariatric surgery Abstract

Introduction: Bariatric surgery is an effective treatment for type 2 diabetes mellitus (T2DM) in patients with morbid obesity. This study investigates whether duration of diabetes and anti-diabetes therapy are associated with glycaemic control after surgery in a routine clinical setting.

Method: A cohort analysis of a prospectively maintained database was carried out for consecutive bariatric operations performed between April 2017 and March 2018 for patients with T2DM.

Results: A total 105 patients with T2DM underwent bariatric surgery (89 Roux-en-Y gastric bypass and 16 sleeve gastrectomy). Median follow-up was 19 months ([interquartile range] IQR 13-24 months). Median weight and body mass index (BMI) on the day of surgery were 125 kg (IQR 103.9- 138.7) and 42.4 kg/m2 (IQR 39-46.8), respectively. At follow- up, 68 patients (64.8%) had achieved remission of diabetes. Patients who were pre-operatively on more than one glucose-lowering medication were less likely to go into remission (odds ratio [OR] 0.13, 95% CI 0.04-0.44, p=0.001) compared to those that were on a single glucose-lowering medication agent. Pre-operative use of insulin therapy (OR 0.09, 95% CI 0.03-0.31, p=<0.001) and SGLT2 inhibitors (OR 0.23, 95% CI 0.05-0.92, p=0.038) were significant negative predictors of remission. Type of operation (p=0.34), pre-operative BMI (p=0.99), and % total weight loss (TWL) (p=0.83) did not predict remission from T2DM after surgery.

Conclusions: Most patients who are medicated for T2DM can stop their glucose-lowering medication after bariatric surgery. Patients who are on multiple glucose-lowering medication agents or those dependent on insulin or SGLT2 inhibitors before bariatric surgery are less likely to undergo complete remission >12 months after bariatric surgery.

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