Preoperative Use of Incretins Is Associated With Increased Diabetes Remission After RYGB Surgery Among Patients Taking Insulin: A Retrospective Cohort Analysis

Type 2 diabetes mellitus (“T2D” or “diabetes,” herein) has significant medical and socioeconomic implications.1 Roux-en-Y gastric bypass (RYGB) surgery is an effective intervention in humans that remits T2D,2 with approximately 60% of patients achieving temporary resolution or durable T2D remission.3,4 RYGB has also been proposed as a therapy for T2D resolution even in cases where weight loss may not be the primary objective5 and particularly for cases with low body mass index (BMI) ranging from 25 to 35 kg/m2.6 Durable T2D remission has been associated with early-stage diabetes7 and significant percent excess body weight loss,8 whereas inability to achieve long-term remission has been associated with inadequate weight loss.9 Glycemic response to gastric bypass has also been correlated with BMI, duration of diabetes, fasting C peptide, and weight loss.10 Young age and low BMI (25–35 kg/m2) have also been associated with long-term T2D remission,6 whereas use of insulin, high HbA1c, and low percent excess body weight loss have been associated with decreased rate of remission after RYGB surgery.11 In the Swedish obese subjects study, 72% of patients experience remission of diabetes within 2 years after surgery but only 36% remained in remission after 10 years.12 In a recent study, patients not taking insulin before RYGB surgery had significantly higher remission rates than patients using insulin (53.8% vs 13.5%).3 Elsewhere, approximately 70% of patients using insulin did not remit diabetes 2 years after RYGB surgery, whereas among noninsulin users only approximately 15% of patients did not remit.13 In general, preoperative use of insulin is associated with low remission rates after RYGB surgery over 5 years.3,13 Here, we show that preoperative addition of incretins could significantly improve remission rates for this group of patients.