• Oliver A Varban, Aaron J Bonham, Arthur M Carlin, Amir A Ghaferi, Jonathath F Finks, and Anne P Ehlers.
• From Department of Surgery (Varban, Ghaferi, Finks), University of Michigan, Ann Arbor, MI.
• J. Am. Coll. Surg. 2022 Oct 1; 235 (4): 654-665.

BackgroundBoth gastric bypass and sleeve gastrectomy can induce diabetes remission. However, deciding which procedure to perform is challenging, because remission rates and morbidity can vary, depending on patient factors as well as disease severity.Study DesignUsing a statewide bariatric-specific data registry, we evaluated all patients undergoing sleeve gastrectomy and gastric bypass between 2006 and 2019 who reported taking either oral diabetic medication alone or who were on insulin before surgery and who also had 1-year follow-up (n=11,664). Multivariate regression was used to identify independent predictors for discontinuation of oral diabetic medication or insulin, respectively, and risk-adjusted complication rates were compared between procedure types among each group.ResultsAt 1-year after surgery, 85.7% of patients reported discontinuation of oral diabetic medication and 66.6% reported discontinuation of insulin. Gastric bypass was an independent predictor for insulin discontinuation (odds ratio 1.17; CI 1.01 to 1.35; p = 0.0329); however, procedure type was not associated with discontinuation of oral medication alone. Risk-adjusted complication rates were significantly higher after gastric bypass than after sleeve gastrectomy, regardless of whether the patient was taking oral diabetic medications alone or was on insulin (11.2% vs 4.8%, p < 0.0001 and 12.0% vs 7.4%, p < 0.0001, respectively).ConclusionsPatients requiring insulin experience higher rates of insulin discontinuation after gastric bypass, but also have significantly higher complication rates when compared to sleeve gastrectomy. However, if patients are on oral diabetic medication alone, rates of medication discontinuation at 1 year are greater than 85% and procedure type is not predictive. Disease severity is an important factor when deciding on the optimal procedure for diabetes.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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