A strong factor associated with failure of diabetes remission after bariatric surgery is the duration of diabetes prior to surgery. Extended delays in bariatric surgery increases the duration and may result in worse outcomes. The purpose of this study was to determine if prolonged time to surgery (TTS) impacted diabetes remission.
We conducted a retrospective study of patients with pre-operative diabetes who underwent roux-en-y gastric bypass surgery (RYGB) from 2002-2018. Diabetes remission was defined as >= 1 year of HbA1c < 6.5% and blood glucose < 125 mg/dL without the use of insulin. After stratifying by insulin use, Cox regression adjusted for DiaRem score, duration of diabetes, and year of surgery was used to evaluate whether TTS>1 year impacted 5-year diabetes remission after bariatric surgery.
1174 patients were included (mean age = 50.0+-10.3 years, BMI = 49.4+-8.8 kg/m2, 73% female). There were no major demographic differences between patients when stratified by TTS (Table 1). Patients without pre-operative insulin requirements (62% of patients) had higher remission rates (Figure 1). In the non-insulin group, TTS >1-year had a lower chance of diabetes remission but this was not statistically significant (HR=0.88, 95% CI=[0.77, 1.00], p=0.057). TTS >1-year was not associated with diabetes remission in the insulin group (HR=0.95, 95% CI=[0.72, 1.26], p=0.726).
Prolonged preoperative bariatric pathways may negatively affect diabetes remission after RYGB in patients with diabetes but not on insulin. Providers should advocate for expedited pathways that avoid delays related to insurance approval or other nonessential delays.