Metabolic Bariatric Surgery Leads to Similar Benefits for Diabetes Management and Glycaemia in Remitters and Non‐Remitters

AIMS: Metabolic bariatric surgery (MBS), for example, Roux-en-Y gastric bypass (RYGB) can lead to diabetes remission. However, this crude dichotomous outcome fails to fully capture post-operative improvements in glycaemia and reduced medication burden in people who do not remit. The objectives of this research were to investigate predictors of diabetes remission in a multiethnic cohort and to detail post-operative improvements in glycaemia and diabetes management. MATERIALS AND METHODS: Prospective observational study of a discovery cohort comprising 67 adults with obesity and Type 2 diabetes, undergoing a standardised RYGB in the United Kingdom or Singapore. Diabetes remission at 12-15 months was the primary outcome. An adjusted HbA1c was calculated using measured HbA1c and the doses/types of diabetes medications to estimate HbA1c without medication. Findings were validated by retrospective clinical audit of a separate UK cohort of 195 individuals undergoing RYGB. RESULTS: Diabetes remission was predicted by diabetes duration, measures of treatment intensity and resulting glycaemia (expressed as adjusted HbA1c) and post-prandial insulin secretion. Both remitters and non-remitters in the discovery cohort showed similar improvements in adjusted HbA1c (-38.2 ± 17.5 mmol/mol vs. -39.5 ± 15.5 mmol/mol, respectively, p = 0.739), a finding confirmed in the validation cohort. CONCLUSIONS: While those who do not experience post-MBS remission have a longer diabetes duration and higher baseline adjusted HbA1c, they benefit similarly from improvements in glycaemia and de-escalation of treatment as those who remit. We suggest that the likelihood of diabetes remission, as assessed by scoring systems, should not be used as a criterion to recommend MBS to patients.