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Changes in Insulin Dependence after Bariatric Surgery
*Ali Ardestani1, *David B Rhoads2, Ali Tavakkoli1
1Brigham and Women's Hospital, Boston, MA;2Massachusetts General Hospital, Boston, MA

Objective:To evaluate the impact of bariatric surgery on insulin dependent patients with Type-2 Diabetes Mellitus (T2DM)
Design:Cohort study from prospectively collected Bariatric Outcomes Longitudinal Database (BOLD)
Setting:National cohort
Patients:Patients with insulin dependant T2DM who have undergone bariatric surgery during 2007-2010
Interventions:Roux-en-Y Gastric Bypass Surgery (RYGB) and Laparoscopic Adjustable Gastric Banding (LAGB)
Main Outcome Measures:Insulin independence and Excess Weight Loss (%EWL)
Results:We identified113,638 adult patients who had undergone bariatric surgery. 10% had insulin-dependent T2DM, from which we analyzed 5,225 patients who had at least one year of follow up. At 12 months 62% of RYGB and 34% LAGB patients were off insulin (Figure 1). Regression models were developed to identify factors that contribute to insulin independence at 1 and 12-months postoperatively (Table 1). At both time points, RYGB was a strong predictor of insulin independence. For LAGB, insulin independence appeared linked to weight loss, while for RYGB the effect appeared to be weight independent in early stages.
Conclusions:With increasing utility of bariatric procedures for treatment of T2DM, RYGB appears to offer a greater chance of insulin independence (over 60% at 1 year), and may be the procedure of choice.

Table 1. Factors that impact insulin independence after bariatric surgery.
Early (1 month)Late (12 months)
Odds Ratio (95% CI)P valueOdds Ratio (95% CI)P value
Sex (%Male)1.02 (0.88-1.19)NS0.85 (0.75-0.96)0.009
Race (%Caucasian)0.94 (0.83-1.10)NS0.95 (0.85-1.05)NS
Procedure (%RYGB)2.21 (1.88-2.61)<0.0011.57 (1.34-1.84)<0.001
Age (years)0.98 (0.98 -1.00)<0.0010.98 (0.98-0.99)<0.001
Preoperative BMI (kg/m2)1.00 (0.99-1.01)NS1.01 (1.00-1.02)0.033
EBWL at 1 month (%)1.03 (1.02-1.04)<0.001NANA
EBWL at 12 months (%)NANA1.02 (1.02-1.03)<0.001


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IMPORTANT DATES
Abstract Submission Deadline:
May 5, 2014

Housing Deadline:
August 13, 2014

Early Bird Registration Deadline:
August 11, 2014
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