Decreased Weight Loss Following Bariatric Surgery in Patients with Type 2 Diabetes

Background Bariatric surgery represents the most effective treatment for achieving significant and sustained weight loss. We aimed to assess whether presence of type 2 diabetes (T2D) at baseline, and T2D remission following bariatric surgery affect the weight loss outcome. Methods Data of 312 consecutive morbidly obese subjects who underwent bariatric surgery were analysed. Patients underwent either RYGB (77%), or sleeve gastrectomy (23%), and their body weight was followed-up for 1, 2, 3, 4, and 5 years at regular ambulatory visits ( N = 269, 312, 210, 151, 105, at each year, respectively). T2D remission was assessed according to the ADA criteria. Results In the whole dataset, 92 patients were affected by T2D. Patients with T2D were older than patients without T2D (52 ± 9 vs 45 ± 11 years, p < 0.0001), but there were no differences in baseline BMI, sex, and type of intervention received. We found that presence of T2D at baseline was associated with smaller weight loss at 1, 2, 3, 4, and 5 years following bariatric surgery ( δ BMI at 2 years: − 13.7 [7.7] vs − 16.4 [7.3] kg/m 2 ; at 5 years − 12.9 [8.8] vs − 16.3 [8.7] kg/m 2 in patients with T2D vs patients without T2D respectively, all p < 0.05). When dividing the patients with T2D in remitters and non-remitters, non-remitters had significantly smaller weight loss compared to remitters ( δ BMI at 2 years: − 11.8 [6.3] vs − 15.4 [7.8] kg/m 2 ; at 5 years: − 8.0 [7.1] vs − 15.0 [7.2] kg/m 2 , non-remitters vs remitters respectively, all p < 0.05). Conclusions T2D is independently associated to smaller weight loss following bariatric surgery, especially in subjects not achieving diabetes remission. Graphical Abstract • Patients with T2D achieve smaller weight loss following bariatric surgery • When dividing the T2D patients in remitters and non-remitters, non-remitters achieve significantly smaller weight loss compared to remitters