eP330 Normalisation of glycaemia in a patient with type 2 diabetes within forty-eight hours of Roux-en-Y gastric bypass surgery

Background The incidence of type 2 diabetes continues to rise, now affecting approximately five million people in the UK and costing the NHS 10% of its annual budget in treatment costs. In some cases, good glycaemic control cannot be achieved through lifestyle or pharmacological interventions and patients may benefit from metabolic (bariatric) surgery, particularly the Roux-en-Y gastric bypass (RYGB). Case History A 57-year-old woman, weighing 135 kg with a BMI of 50 kg/m², presented with a 7-year history of type 2 diabetes. Despite optimising her medication with oral drugs and GLP-1 agonists, her HbA1c remained at 80 mmol/mol due to medication intolerance and insufficient efficacy. She underwent RYGB, following which she was placed on a subcutaneous insulin sliding scale. Her insulin requirement was low, and post-operatively blood glucose levels remained normal. The sliding scale was discontinued 48 hours after the surgery, and normoglycaemia persisted. The patient remained in hospital for three days and was discharged on metformin and sitagliptin, with plans to stop these medications if normoglycaemic at home. Learning Points After years of sub-optimal glycaemic control, normoglycaemia was achieved within 48 hours following bariatric surgery. This effect occurs prior to weight loss and reflects a post-operative elevation in gut hormones such as GLP-1. Bariatric surgery is a cost-effective and highly efficacious treatment for type 2 diabetes, particularly for cases resistant to pharmacological therapy. It should be considered as part of a multidisciplinary approach to diabetes management when conservative and medical treatments fail.