The role of socioeconomic status in resolution of type 2 diabetes mellitus following longitudinal sleeve gastrectomy

The role socioeconomic status (SES) on outcomes following bariatric surgery has been heavily investigated in previous studies. The goal of this study is to determine the association between Area Deprivation Index (ADI), a multidimensional indicator of socioeconomic conditions, and remission of type 2 diabetes mellitus following longitudinal sleeve gastrectomy (SG).

This is a retrospective analysis of 312 patients undergoing LSG at a single-center in a metropolitan hospital setting over two years. Socioeconomic disadvantage was assessed by ADI, a model that incorporates education, income, employment and housing stock to rank neighborhoods both on the state and the national level. Type 2 diabetes mellitus (T2DM) was defined as utilization of diabetes medication or HgA1C of greater than 6.5% within a 3 months period, and was assessed at three time points: pre-op, 6-month follow-up and 1-year follow-up.

In this cohort of individuals presenting for LSG, 72 (23.1%) had T2DM. The mean ADI of patients with T2DM (41.1 ± 17.1) was not statistically different from the group without T2DM (45.0 ± 16.4; p = 0.08631). By one year follow-up, 39 (60.0%) of individuals with T2DM had achieved remission. The ADI for individuals that achieved T2DM resolution was not different from the ADI of the group that did not (38.1 ± 15.4 vs 45.3 ± 17.7; p = 0.0958). In individuals with T2DM at baseline, 47 (65%) had A1C pre-op and A1C at 1 year follow-up; there was a significant reduction in Hgb-A1c (−0.71; −12.3%; p < 0.01). There was no correlation between change in A1C at 1 year and ADI national rank (p = 0.26).

We did not find a significant association between ADI and resolution of T2DM following sleeve gastrectomy. Resolution of T2DM following SG can be achieved by individuals regardless of SES. This supports the continued use of SG for socioeconomically deprived populations. In addition, we did not find an association between resolution of T2DM and weight loss, the most commonly used outcome metric following bariatric surgery