Independent Predictors of Discontinuation of Diabetic Medication after Sleeve Gastrectomy and Gastric Bypass
Varban OA, Bonham AJ, Carlin AM, Ghaferi AA, Finks JF, and Ehlers AP. Independent Predictors of Discontinuation of Diabetic Medication after Sleeve Gastrectomy and Gastric Bypass. J Am Coll Surg 2022.
Journal of the American College of Surgeons
INTRODUCTION: Both gastric bypass and sleeve gastrectomy can induce diabetes remission. However, deciding which procedure to perform is challenging since remission rates and morbidity can vary depending on patient factors as well as disease severity.
METHODS: Using a state-wide bariatric-specific data registry we evaluated all patients undergoing sleeve gastrectomy and gastric bypass between 2006-2019 who reported taking either oral diabetic medication alone or who were on insulin prior to surgery and who also had 1-year follow-up (n=11,664). Multivariate regression was used to identify independent predictors for discontinuation of oral diabetic medication or insulin, respectively, and risk-adjusted complication rates were compared between procedure types among each group.
RESULTS: At 1-year after surgery, 85.7% of patients reported discontinuation of oral diabetic medication and 66.6% reported discontinuation of insulin. Gastric bypass was an independent predictor for insulin discontinuation (OR 1.17, CI 1.01-1.35, p=0.0329), however procedure type was not associated with discontinuation of oral medication alone. Risk adjusted complication rates were significantly higher after gastric bypass than sleeve gastrectomy, regardless of whether the patient was taking oral diabetic medications alone or was on insulin (11.2% vs 4.8%, p<0.0001 and 12.0% vs 7.4%, p<0.0001, respectively).
CONCLUSIONS: Patients requiring insulin experience higher rates of insulin discontinuation after gastric bypass but also have significantly higher complication rates when compared to sleeve gastrectomy. However, if patients are on oral diabetic medication alone, rates of medication discontinuation at 1 year are greater than 85% and procedure type is not predictive. Disease severity is an important factor when deciding on the optimal procedure for diabetes.
ePub ahead of print