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INTRODUCTION: Surgical treatment for morbid obesity via Laparoscopic Roux-en-Y Gastric Bypass (LRNYGB) leads to weight loss and remission of diabetes in most patients with type 2 diabetes mellitus (T2DM). The outcomes in patients taking GLP-1 analogues for glycemic control are not well understood. We analyzed the rate of remission of T2DM in patients after gastric bypass surgery with respect to the diabetic medications taken preoperatively.

METHODS: 157 patients with T2DM were studied. Baseline demographics, hemoglobin A1C levels, and medication lists were evaluated for patients undergoing LRNYGBP between January 2005 and December 2009.

RESULTS: The mean age was 50 years, 73.9% were female, mean BMI at surgery was 47.6. Mean follow-up was 2.34 years. 79.0% of patients were off medications for T2DM at last follow-up. 19.1% of patients were on a GLP-1 analogue at the time of surgery. The average preoperative hemoglobin A1c level was higher in this group (6.92 vs 6.80), but no other significant differences were found. The rate of remission of diabetes was not significantly different between patients on a GLP-1 analogue and others (80.0% vs 78.7%). Remission rates did not vary according to the number of anti-diabetic agents taken at the time of surgery (91.1% for 1, 89.6% for 2, 90.0% for 3 or 4). Multivariate regression analysis revealed preoperative insulin use to be the only significant predictor of postoperative T2DM status (RR 5.48, 95% CI 2.91 to 10.30).

CONCLUSIONS: The use of GLP-1 analogues in patients who undergo LRNYGBP surgery is not associated with improved glycemic control, lower BMI at the time of surgery, or improved long term outcomes. Preoperative insulin use is a risk-factor for non-remission of T2DM postoperatively. Surgical intervention prior to insulin dependence is needed to maximize long term remission rates. Early surgical intervention for morbidly obese patients with T2DM should be considered instead of escalation of medical management.