MON-886 - The Effect of Post-Operative GLP-1 RAs on HbA1c Levels and Diabetes Remission Among Bariatric Surgery Patients with Diabetes: A Real-World Study

In addition to weight loss benefits, bariatric surgery is an effective treatment for type 2 diabetes. Results from a clinical trial show a reduction in HbA1c of -2.5% and a 40.5% remission rate (HbA1c < 6.5%) at 60 months for patients with type 2 diabetes who underwent a sleeve gastrectomy (SG) procedure. Clinical studies have shown that glucagon-like peptide-1 receptor agonists (GLPs) are effective post-surgery therapies for mitigating insufficient weight loss and weight regain, but their impact on post-surgery diabetes-related outcomes remains understudied. Thus far, clinical evidence has demonstrated a placebo-adjusted HbA1c change of -0.3% at 56 weeks for patients initiating liraglutide after surgery, while other clinical trials have reported only non-significant differences. This retrospective analysis of electronic health records from all 6 University of California academic health centers examined patients with diabetes who were eligible for bariatric surgery and compared the 18-month change in HbA1c and diabetes remission rates between those who only underwent bariatric surgery (36.6% RYGB and 63.4% SG) to those who had bariatric surgery and initiated a GLP medication that they remained adherent to for at least three months (26.6% RYGB and 73.4% SG). Analyses were stratified by GLP type (9.8% dulaglutide, 10.1% liraglutide, 56.2% semaglutide, and 23.9% tirzepatide) as well as surgery type. Change in HbA1c over time was estimated using a mixed-effects regression model, and the odds of diabetes remission were calculated using multiple logistic regression. Following our selection protocol, 891 patients who only underwent bariatric surgery and 297 patients who underwent bariatric surgery and had their first GLP within a year were included in this study. Change in HbA1c at 18 months was estimated to be -1.66% and -1.29% for RYGB patients taking GLPs and those who only had surgery, respectively. For SG patients, we estimated an 18-month change in HbA1c of -0.67% and -0.51% for GLP and surgery only patients, respectively. Compared to patients who only received bariatric surgery, dulaglutide, liraglutide, semaglutide, and tirzepatide patients had a 3.44 (95% CI 2.91, 4.08), 1.68 (95% CI 1.42, 2.00), 0.68 (95% CI 0.62, 0.75), and 0.48 (95% CI 0.40, 0.56) times respective odds of diabetes remission within the first 18 months following surgery. This study provides real-world evidence that GLPs taken adherently within the first year following bariatric surgery may lead to a lower average HbA1c and higher odds of diabetes remission at 18 months.