Background: GLP1RAs are an increasingly common treatment in the setting of type 2 diabetes mellitus (T2DM). One hypothesized mechanism by which bariatric surgery contributes to T2DM remission is by increasing intestinal GLP-1 secretion. We aimed to evaluate the association of the response to GLP1RA pre-operatively on hemoglobin A1c (HbA1c) level and weight loss after bariatric surgery.

Methods: The NorthShore bariatric surgery database was retrospectively queried for patients with T2DM who had taken a GLP1RA prior to Roux-en-Y gastric bypass (N=38) or gastric sleeve surgery (N=9). GLP1RA response was measured by change in HbA1c from initiation of therapy to 6mo. Outcomes included HbA1c level and percent total body weight loss (TBWL) at 6mo, 1 and 2yr post-op. The association between GLP1RA response and post-operative outcomes was evaluated with partial correlation coefficients adjusted for baseline HbA1c with/without baseline weight.

Results: The average HbA1c at initiation of therapy was 8.3±1.4% and decreased by 1.1±1.5% on GLP1RA treatment with liraglutide being most commonly prescribed (44.7%). A greater decrease in HbA1c from GLP1RA was correlated with a lower HbA1c at 6mo (r=0.38, p=0.02), and 2yr (r=0.43, p=0.03), but not 1yr (r=0.35, p=0.06) or TBWL. After adjustment for baseline weight, the association remained at 6mo (r=0.37, p=0.02). Stratification by procedure noted a strong association between GLP1RA response and reduced post-operative HbA1c at 6mo (r=0.99, p<0.01) and TBWL at 1yr (r=0.82, p=0.02) and 2yrs (r=0.99, p=0.01) for patients who had undergone gastric sleeve, but not gastric bypass.

Conclusion: To our knowledge, this is the first study examining the association of GLP1RA response on glycemic and weight outcomes post-bariatric surgery in people with T2DM. Despite a number of limitations, results from this small cohort suggest the need for further evaluation of this relationship as a potentially useful predictor of surgical outcomes.


D. Amusin: None. K. Kuchta: None. T. Ewing: None. L. Tucker: None. M. Campbell: None. M. Ujiki: Advisory Panel; Self; Boston Scientific Corporation, Consultant; Self; Cook Medical, Speaker’s Bureau; Self; Medtronic. L. K. Billings: Advisory Panel; Self; Bayer Inc., Lilly Diabetes, Novo Nordisk, Sanofi.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at