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Wissam Ghusn*1, Kayla Ikemiya2, Karim Al Annan1, Donna Maria Abboud1, Marita Salame1, Karl Hage1, Todd A. Kellogg1, Andres Acosta1, Edmund Lee3, Konstantinos Spaniolas3, Kelvin Higa2, Pearl Ma2, Omar M. Ghanem1
1Mayo Foundation for Medical Education and Research, Rochester, MN; 2University of California San Francisco Fresno, Fresno, CA; 3Stony Brook University, Stony Brook, NY

Type 2 diabetes mellitus (T2DM) is a common comorbidity associated with obesity, particularly in patients with body mass index [BMI]≥ 50 kg/m2. Due to the high morbidity and mortality risks associated with T2DM, its treatment is of utmost importance. Roux-En-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been shown to be two of the most effective interventions for weight loss and metabolic improvement. However, T2DM remission is widely variable between patients with different baseline characteristics. We aim to study real-world long-term T2DM remission in patients with BMI ≥50 kg/m2 following bariatric surgeries.
This is a retrospective chart review of the electronic medical records (EMR) of all patients with BMI≥ 50 kg/m2, with T2DM, and have undergone RYGB or SG from January 2008 to December 2017 at three tertiary referral centers in the US. We collected demographic, clinical, and metabolic data at baseline and annually until 14 years post-bariatric surgery. T2DM remission was defined as HbA1c <6.5% and off anti-diabetes medications. Our primary outcome included assessing T2DM parameters (e.g., remission, HbA1, and fasting glucose) after bariatric surgery using the matched paired t-test. The secondary outcomes included determining the predictors of T2DM remission in patients with BMI≥ 50 kg/m2 via a multivariate logistic regression. Statistical significance was set at 2 sided p<0.05. Data are presented as mean ± standard deviation.
A total of 329 patients with T2DM (50.1 ±11.7 years, 64% females, 89% white, BMI 56.8± 6.1 kg/m2) were analyzed in this study (Table 1). In this cohort, 63% had undergone RYGB and 37% SG, with a mean follow up of 5.7± 3.5 years. T2DM remission at last follow-up visit was demonstrated in 53.9% of patients with follow-up. There was a significant improvement of HbA1c, fasting glucose, number of T2DM, and weight loss outcomes between baseline and last follow-up (p< 0.05; Figure 1 A-F). We performed a multivariate logistic regression including age, sex, race, BMI, procedure type, baseline HbA1c, baseline fasting glucose, duration of T2DM, and number of anti-diabetic medications in the T2DM remission model. The duration of T2DM (p< 0.001) and number of T2DM medications (p=0.02) were the only factors reported to be predictive of T2DM remission. After controlling for baseline characteristics, there was no difference in T2DM remission rate between RYGB and SG (p=0.1).
In our cohort of patients with BMI≥ 50 kg/m2, RYGB and SG demonstrated similar long-term weight loss outcomes and significant T2DM improvement. However, more studies with larger sample sizes are needed to better understand the long-term metabolic effects of bariatric surgeries.

Table 1: Demographic and Clinical Information.
Data are presented as mean and standard deviation for continuous variables, and as frequency and percentage for categorical variables.

Figure 1: HbA1c progression (A), change in HbA1c (B), patients with T2DM diagnosis (C), fasting glucose (D), T2DM medication number (E), and BMI (F) between baseline and last follow-up.

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