Metabolic Surgery Counseling, Diabetes Remission, and A1C Control in Patients with Diabetes and Obesity

Metabolic surgery (MS) can lower A1c and achieve DM remission. Counseling by a healthcare provider is an important initial step in considering MS. We hypothesized that MS counseling results in a significant increase in DM remission and A1c improvement. We retrospectively studied 3,676 adults aged 18-65 with T2DM, BMI ≥35 kg/m2, and A1c ≥6.5% followed at two academic medical centers between 2000-2015, using a software tool to identify MS counseling in EMR notes. Counseling and outcomes were assessed over one and three years after study entry, respectively. Study patients’ mean age was 50.8 years and mean baseline A1c was 8.2%. Over one year after study entry, 20.2% of patients had MS counseling. In univariate analyses, patients who received MS counseling had a higher rate of DM remission (A1c<6.5% and no DM medications besides metformin) and were more likely to have achieved A1c control (<7.0%) vs. those who did not (Figure). In multivariable analyses adjusted for patient demographics and comorbidities, MS counseling was associated with an OR of 1.43 (95% CI 1.11-1.84; p=.0051) for achieving DM remission and an OR of 1.44 (95% CI 1.15-1.81; p=.0015) for achieving A1c control. In this large study of patients with T2DM and obesity, MS counseling was associated with significantly greater rates of DM remission and A1c control. These findings suggest MS counseling is an important step in the treatment of DM and obesity.