A. Valencia1, L. Garcia1, D. Azagury1, H. Rivas1, J. M. Morton1 1Stanford University,Bariatric and Minimally Invasive Surgery,Palo Alto, CA, USA
Introduction: Previous studies have demonstrated that persons from lower socioeconomic and racial/ethnic minority backgrounds are more likely to qualify for bariatric surgery. Despite notable research regarding access to bariatric surgery, there remains a need to assess differences in metabolic outcomes among racial/ethnic groups and across time. This study assesses ethnic differences in diabetes outcomes following bariatric surgery.
Methods: A retrospective analysis including 745 patients with type 2 diabetes (T2D) who underwent Roux-en-Y gastric bypass (RYGB) surgery was conducted to understand racial/ethnic disparities in metabolic outcomes over time. Data were collected from a bariatric database including patients treated at an academic medical center in California. Non-Hispanic White (NHW), Hispanic, Black, Asian, and Pacific Islander racial/ethnic groups were identified using self-reported data. T2D was defined as having one of the following criteria: a fasting glucose concentration >125 mg/dL, HbA1c >6.5%, and taking one or more diabetic medications. Patients who had a fasting glucose <100 mg/dL, HbA1c <6.5%, and were not on diabetic oral medications were considered to have resolved T2D. Within-group comparisons were made using paired t-tests.
Results:Significant reductions in BMI, body weight, fasting glucose, and HbA1c were observed for all racial/ethnic groups six months after RYGB. However, whereas NHW, Hispanic, and Black patients benefited from an additional and statistically significant reduction in BMI 12 months after surgery, this effect was not observed among Asian or Pacific Islander patients. In addition, NHW and Hispanic cohorts experienced additional reductions in fasting glucose and HbA1c at 12 months of follow up, but there were no further improvements in glucose metabolism among the Black, Asian, or Pacific Islander groups. Significant improvements in triglycerides, total cholesterol, HDL-C, and LDL-C were observed for NHWs, Hispanics, and Blacks but not for Asians and Pacific Islanders. T2D was resolved in 94% of Hispanics, 94% of Asians, 89% of NHWs, 87% of Blacks, and 75% of Pacific Islanders.
Conclusion: This study demonstrates that RYGB was an effective treatment for normalizing glucose metabolism among patients with type 2 diabetes, regardless of racial/ethnic group. However, Asians and Pacific Islanders did not continue to benefit from improvements in BMI, fasting glucose concentrations, or HbA1c between 6 and 12 months after surgery. These results suggest the need to provide Asian and Pacific Islander patients with additional support for achieving similar longitudinal metabolic improvements as NHW and Hispanic counterparts.