title: Preoperative use of incretins is associated with increased diabetes remission after RYGB surgery among patients taking insulin: a retrospective cohort analysis.
abstract: OBJECTIVE
  The main goal of this study was to determine the effects of incretins on type 2 diabetes (T2D) remission after Roux-en-Y gastric bypass (RYGB) surgery for patients taking insulin.
  
  
  BACKGROUND
  Type 2 diabetes is a chronic disease with potentially debilitating consequences. RYGB surgery is one of the few interventions that can remit T2D. Preoperative use of insulin, however, predisposes to significantly lower T2D remission rates.
  
  
  METHODS
  A retrospective cohort of 690 T2D patients with at least 12 months follow-up and available electronic medical records was used to identify 37 T2D patients who were actively using a Glucagon-like peptide 1 (GLP-1) agonist in addition to another antidiabetic medication, during the preoperative period.
  
  
  RESULTS
  Here, we report that use of insulin, along with other antidiabetic medications, significantly diminished overall T2D remission rates 14 months after RYGB surgery (9%) compared with patients not taking insulin (56%). Addition of the GLP-1 agonist, however, increased significantly T2D early remission rates (22%), compared with patients not taking the GLP-1 agonist (4%). Moreover, the 6-year remission rates were also significantly higher for the former group of patients. The GLP-1 agonist did not improve the remission rates of diabetic patients not taking insulin as part of their pharmacotherapy.
  
  
  CONCLUSIONS
  Preoperative use of antidiabetic medication, coupled with an incretin agonist, could significantly improve the odds of T2D remission after RYGB surgery in patients also using insulin.
authors.affiliation: *Institute of Obesity, Geisinger Health System, Danville, PA †Department of Biochemistry and Molecular Biology and Department of Pathology and Laboratory Medicine, Pennsylvania State University, Hershey, PA ‡Department of Surgery, Geisinger Health System, Danville, PA §Department of Internal Medicine, Geisinger Health System, Danville, PA ¶Weis Center for Research, Geisinger Health System, Danville, PA.
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Gerhard
authors.forename: Peter
authors.initials: P
authors.lastname: Benotti
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Petrick
authors.forename: Jon D
authors.initials: JD
authors.lastname: Gabrielsen
authors.forename: William E
authors.initials: WE
authors.lastname: Strodel
authors.forename: Anna
authors.initials: A
authors.lastname: Ibele
authors.forename: David D
authors.initials: DD
authors.lastname: Rolston
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Still
authors.forename: George
authors.initials: G
authors.lastname: Argyropoulos
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000601:surgery*; D015390:Gastric Bypass; D052216:Glucagon-Like Peptide 1 / Q000819:agonists*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D054795:Incretins / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D057234:Preoperative Period; D012074:Remission Induction; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D052216:Glucagon-Like Peptide 1