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

Background: 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. Objectives: The aim is to identify remission rates of DM2 among patients using glucocorticoids after bariatric surgery and assess long-term postsurgical follow-up. Methods: 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. Results: 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. Conclusions: Patients who use systemic glucocorticoids are able to achieve diabetes remission after bariatric surgery. Concurrent therapy with tacrolimus is associated with worse remission outcomes.