POOR GLYCEMIC CONTROL IN BARIATRIC PATIENTS: A REASON TO DELAY OR A REASON TO PROCEED?

ABSTRACT Introduction More than 90% of type II diabetics (T2D) have obesity, and over 85% of diabetic patients who undergo metabolic and bariatric surgery (MBS) will see improvement or resolution of diabetes. However, diabetes is a known risk factor for surgical complications. It is unclear whether poor preoperative glycemic control confers an increased perioperative risk after MBS. Methods From the 2017-2018 MBSAQIP databases, we identified patients with diabetes who underwent Roux-en-Y gastric bypass (RYGB) or gastric sleeve (SG). Unmatched and propensity-matched univariate analysis, as well as multivariate logistic regression were performed to compare thirty-day postoperative outcomes and complication rates between patients with poor (HbA1c>7.0) and good glycemic control (HbA1c Results Of 40,132 T2D patients, 19,094 (52.42%) had HBA1c Conclusions In T2D patients, poor glycemic control does not independently increase the risk of 30-day morbidity following MBS. Adverse outcomes in the setting of poor glycemic control appear to be largely mediated by associated comorbidities. Performing MBS in the setting of suboptimal glycemic control may be justified, with the understanding that delaying or refusing surgery can contribute to worsening of diabetes-related comorbidities, and these in turn may ultimately have a more deleterious effect on outcomes.