1165-P: Glycemic Normalization following Vertical Sleeve Gastrectomy (VSG) in Youth with Type 2 Diabetes (T2D)

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Introduction and Objective: Bariatric surgery improves glycemic control in youth with T2D, but few data exist on glycemic patterns post-operatively (post-op). We examined post-op blood glucose (BG) levels and glycemic variability following VSG using continuous glucose monitoring (CGM) in youth with obesity and T2D as part of the Surgical or Medical Treatment for Pediatric T2D (ST2OMP) study. Methods: CGM data were assessed in 20 youth following VSG starting a mean 2.3 days (range 1-6) post-VSG, for a total mean of 13.7 days (range 6.8-22.4). CGM data were analyzed using R statistical software (iglu package). Pre-op HbA1c was compared to HbA1c estimated from the post-op CGM glucose management indicator (GMI). Mean amplitude of glycemic excursion (MAGE) and time in range (TIR) were also calculated. Results: The cohort was a mean age of 17.1 yrs, 50% Hispanic, 63% White, 21% Black, and 58% female. Pre-op, 15/20 youth had HbA1c in the prediabetes (n=5) and T2D (n=10) range. Post-op GMI was normal in 16/20, in the prediabetes range for 3/20, and in the T2D range for 1/20 (none on diabetes medication). Comparing pre-op HbA1c to post-op GMI, estimated HbA1c decreased 1.9% (CI 1.11-2.76, p < 0.001). HbA1c decrease was greater in youth with pre-op HbA1c in the T2D range (n=10), with an estimated HbA1c decrease of 3.3% (CI 2.23-4.39, p < 0.001). Residual hyperglycemia (BG>200mg/dL) was seen in 2/20 post-op and these youth had the highest pre-op HbA1c. Two of 20 youth had BG < 54mg/dL post-op. Fourteen of 20 youth had >70% TIR and 14/20 had normalization of glycemic variability (MAGE <32). Conclusion: Glycemic normalization for youth with T2D was seen in the immediate VSG post-op period in most youth, despite minimal weight loss. Higher glycemia pre-op was associated with continued hyperglycemia post-op. Hypoglycemia may be a concern in a small subgroup immediately following VSG. Continued follow-up of this cohort will inform longer-term glycemia and whether early glycemia predicts later glycemic outcomes. Disclosure N.R. Segev: None. K.J. Nadeau: None. M.M. Kelsey: Research Support; Rhythm Pharmaceuticals, Inc. L.R. Schaaf: Advisory Panel; Novo Nordisk. A. Baumgartner: None. A. Riegler: None. K. Wiitala: None. T.M. Jenkins: None. S. Xanthakos: None. M. Helmrath: None. T. Inge: Consultant; Mediflix, UpToDate, Teleflex, Medtronic, Eli Lilly and Company, BrainStorm Cell Therapeutics, Standard Bariatrics. A.S. Shah: None. Funding National Institute of Health (R01DK119450); Abbott (CGM support)

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