Background: Laparoscopic sleeve gastrectomy (SG) achieves type 2 diabetes (T2D) remission to various extents, and reasons for such variations are unknown. Objectives: We assessed patients' characteristics associated with T2D remission 1 year post SG. Setting: University hospital. Methods: Retrospective study of 230 T2D patients (18-64 yr) who underwent SG at our institution. We examined pre-and postoperative demographic, anthropometric, biochemical, and clinical characteristics associated with T2D complete remission, partial remission, improvement, or unchanged status. Independent predictors of T2D complete remission were assessed by binary logistic regression and then included in 7 predictive models. Logistic regression assessed the pre-and postoperative predictors of T2D complete remission and their predictive performance was measured with the area under the curve of the receiver operating characteristic curve. Results: A total of 230 patients were included in the study, females comprised 69%, and mean age was 45.66 6 8.84 years. Mean preoperative weight and body mass index were 115.69 6 20.76 kg and 43.53 6 6.98 kg/m 2 , respectively. Approximately two thirds (64.4%) of the sample had diabetes for .5 years. Insulin therapy users comprised 36.9% of the sample and 29.6% of patients were on 2 oral hypoglycemic agents (OHA). At 1 year, mean body mass index was 32.77 6 6.09 kg/m 2 , percent excess weight loss (%EWL) was 62.29 6 23.60% and glycosylated hemoglobin (HbA1C) improved from 8.1% to 6.18%. Approximately 42.2% of the sample achieved T2D complete remission. Compared with those with no remission, patients with complete remission were significantly younger, had shorter duration of diabetes, were not on insulin therapy, took fewer OHA, had higher C-peptide, lower preoperative HbA1C, were less likely to have had hypertension or dyslipidemia, and more likely to have achieved higher %EWL. Seven proposed models for prediction of complete remission showed the most useful model comprised diabetes duration 1 pre-HbA1C 1 %EWL 1 insulin therapy 1 age 1 OHA (area under the curve 5 .81). Independent predictors of complete remission were preoperative HbA1C, %EWL, insulin therapy, age, and OHA (but not diabetes duration).

Purpose Bariatric surgeries are common procedures due to the high prevalence of obesity. This study aimed to investigate whether bariatric surgery increases fracture risk. Material and Methods It was a case-controlled study. Patients who underwent bariatric surgery during 2011 and 2012 were matched for age (± 5 years) and gender to patients on medical weight management during the same period with a ratio of 1:2. The index date was defined as the date of bariatric surgery for both groups. The subject’s electronic medical records were reviewed retrospectively to identify fractures documented by radiology during January 2020. Results Randomly selected 403 cases were matched to 806 controls with a median age of 36.0 years (IQR 14.0) and 37.0 years (IQR 14.0), respectively. Seventy per cent of the cohort were females. Eighty per cent received sleeve gastrectomy, and the remaining (17%) underwent gastric bypass. The mean duration of follow-up was 8.6 years. The fracture rate was higher in the surgical group as compared to the controls (9.4% vs 3.5%) with a crude odds ratio of 2.71 (95% CI 1.69–4.36). The median duration for time to fracture was 4.17 years for the surgical group and 6.09 years for controls (p-value = 0.097). The most common site of fractures was feet, followed by hands. Apart from a few wrist fractures, there was no typical osteoporotic sites fracture. Conclusion Subjects who underwent bariatric procedures had more non-typical osteoporotic site fractures affecting mainly feet and hands, and fractures tend to occur earlier as compared to controls. Graphical abstract

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