Diabetes Remission After Bariatric Surgery in Patients on Glucocorticoids: A Pilot Study

Diabetes mellitus type 2 (DM2) remission after bariatric surgery has long been reported in the medical literature. Glucocorticoid use is associated with weight gain and could theoretically affect diabetes remission post bariatric surgery.

The aim is to identify remission rates of DM2 among patients using glucocorticoids after bariatric surgery and assess long-term postsurgical follow-up.

A retrospective analysis was performed on patients who used glucocorticoids and underwent bariatric surgery at the Mayo Clinic between 2008 and 2020. Data were analyzed for 3-month, 6-month, 1-year, 2-year, and 5-year intervals for factors indicative of diabetes remission.

Within our retrospective search, we identified 92 patients who were on any immunosuppressant medication before surgery. Of those, 22 patients had a diagnosis of DM2 while 18 of them were concurrently on glucocorticoids. Diabetes remission occurred in 11 of the 18 DM2 patients (61.11%). There was a statistically significant negative correlation between diabetes remission and combination therapy with glucocorticoids and tacrolimus (P=0.016); patients with a longer duration of DM2 diagnosis (P=0.024), and patients who used insulin three months after the procedure (P=0.001). However, percent total weight loss and the number of preoperative oral DM2 medications were not associated with worse outcomes.

Patients who use systemic glucocorticoids are able to achieve diabetes remission after bariatric surgery. Concurrent therapy with tacrolimus is associated with worse remission outcomes.