1729-P: Insulin Resistance Cutoff for High Probability of Blood Glucose Normalization in T2DM Patients with Obesity after Bariatric Surgery

There are several models of T2DM remission after bariatric surgery (ABCD, DiaRem, DRS), but none of them includes insulin resistance. Moreover these models are not suitable for early prediction of T2DM remission (within several months after surgery).

Methods: We included 42 patients with T2DM and morbid obesity (BMI 42.3 [38.9; 48.1] kg/m²) after bariatric surgery (16 pts after restrictive procedures and 26 pts after bypass surgery). Insulin resistance was measured by hyperinsulienic euglycaemic test with M-index estimation (mg/kg/min) and HOMA-IR before the surgery. Glycaemia normalization was assessed by self-monitoring of blood glucose (FPG < 110 mg/dl (6.1 mmol/l) and postprandial PG < 140 mg/dl (7.8 mmol/l) in 1 month after surgery) as well as HbA1c < 6.0% (42 mmol/mol) in 3 months after surgery. ROC-curve identified insulin resistance predictive value of blood glucose normalization after bariatric surgery. Statistical analysis was performed using SPSS v.23.0.

Results: All patients had severe insulin resistance at baseline (median M-index before surgery 1.535 mg/kg/min, HOMA-IR 10.0). Within 1 month after surgery 7 patients (16,7%) reached blood glucose normalization, within 3 months - 22 patients (52,4%), within 6 months - 31 patient (73,8%), in 12 months - 35 patients (83,3%). ROC-analysis showed that M-index within 1st month after surgery was predictive of blood glucose normalization; insulin resistance cut-off value was 1.876 mg/kg/min (Youden’s index). HOMA-IR and M-index in 3, 6 and 12 months after surgery didn’t predict glycaemia normalization.

Conclusion: Baseline insulin resistance value defined as M-index > 1.876 mg/kg/min can be used to predict early blood glucose normalization within 1 month after bariatric surgery.