OBJECTIVES : Benefits of revisional bariatric surgeries is poorly studied in patients with diabetes mellitus patients. The objective of this study is to assess their impact on Antidiabetes Treatments.

METHODS : An extraction from the French nationwide healthcare database targeted all patients who underwent bariatric surgery for the first time during 2012-2014 and were followed until end of 2017. Revisional bariatric surgery included Sleeve Gastrectomy (SG) and Gastric By-Pass (GBP), Adjustable Gastric Banding (AGB) remained anecdotal.

We analysed the evolution of the number of diabetic patients, and the impact of a revisional bariatric surgery on the reimbursement of associated treatments (monotherapy, bi/tritherapy, insulin).

RESULTS

: 112 809 patients were included, 12% of them (n=9 066) were diabetic in the year before initial surgery.

During the follow-up, 4 836 (4.3%) patients, including 368 (8%) diabetic patients, underwent revisional bariatric surgery. Diabetes was treated with monotherapy, bi/tritherapy and insulin in respectively 39%, 32% and 30% of cases. 42% of diabetic patients stopped their treatment after the revisional surgery and this result was heightened for patients with monotherapy (68%) compared with bi/tritherapy (34%) or insulin (20%). There is no difference in interrupting monotherapy or bi/tritherapy according to the type of procedure (68% [GBP] vs. 70% [SG] for monotherapy, 35% [BP] vs 35% [SG] for bi/tritherapy). The interruption of insulin was more frequently increased after a GBP than a SG (23% vs. 10%). 43% of diabetic patients maintained their treatments after the second surgery, but this percentage was lower after a GBP than a SG (41% vs. 47%).

CONCLUSIONS

: This preliminary study shows the interest of revisional surgery in reduction of Antidiabetes Treatment. These results seem to differ according to the type of procedure, the procedures sequence, and the profile of the patient. A multivariate analysis depending on procedures sequences is to be followed.