Trajectories of Type 2 Diabetes Following Bariatric Surgery: A Propensity Score-Matched, Sex-Specific Comparative Study

Background Metabolic and bariatric surgery (MBS) yields high rates of Type 2 Diabetes (T2D) remission. However, the existing literature on sex-specific T2D resolution is inconsistent, often limited by methodological factors, and rarely captures the complete postoperative T2DM trajectory. Aims To comprehensively evaluate sex-specific T2D trajectories, glycemic control, and medication use following Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) while minimizing potential confounding. Methods Setting: University Medical Center. Patients with T2D undergoing primary SG or RYGB were included in a retrospective cohort study. A 1:1 propensity score matching created a balanced cohort (n=210) based on age, BMI, surgical procedure, and multiple T2D severity indicators. The overall follow-up rate was 83.7%. T2D trajectories, medication changes, A1C levels, weight loss metrics, and complications were analyzed at 6, 12, 24, and 36 months postoperatively. Results T2D trajectories, changes in medication and A1C levels showed no significant differences between sexes or between SG and RYGB within either sex group. Overall complication rates did not differ between sexes, but RYGB was associated with significantly higher rates of severe complications (Grade ≥IIIa/b) than SG in both groups. Weight loss metrics were comparable early, but females showed significantly greater weight loss at 24 and 36 months. Predictors for remission included lower age, lower A1C, no insulin use, and higher C-peptide. Conclusion T2D outcomes after MBS were comparable between females and males, and between procedures, over 36 months. T2D remission was associated with age and baseline disease severity, not sex or procedure type.