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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 value	Odds Ratio (95% CI)	P value
Sex (%Male)	1.02 (0.88-1.19)	NS	0.85 (0.75-0.96)	0.009
Race (%Caucasian)	0.94 (0.83-1.10)	NS	0.95 (0.85-1.05)	NS
Procedure (%RYGB)	2.21 (1.88-2.61)	<0.001	1.57 (1.34-1.84)	<0.001
Age (years)	0.98 (0.98 -1.00)	<0.001	0.98 (0.98-0.99)	<0.001
Preoperative BMI (kg/m2)	1.00 (0.99-1.01)	NS	1.01 (1.00-1.02)	0.033
EBWL at 1 month (%)	1.03 (1.02-1.04)	<0.001	NA	NA
EBWL at 12 months (%)	NA	NA	1.02 (1.02-1.03)	<0.001