Preoperative predictors of persistent enteropathic diarrhea after one-anastomosis gastric bypass in patients with type 2 diabetes mellitus

Background Persistent enteropathic diarrhea is a quality-of-life-limiting complication after one-anastomosis gastric bypass (OAGB). Patients with type 2 diabetes mellitus (T2DM) may be especially vulnerable owing to subclinical diabetic enteropathy and reduced pancreatic exocrine reserve, but no validated preoperative tool identifies them. We aimed to identify and internally validate routine preoperative predictors of persistent enteropathic diarrhea 12 months after OAGB in a T2DM cohort. Methods In this single-center prospective cohort of 87 consecutive patients with T2DM who underwent primary OAGB (January 2020 – December 2024) and completed ≥ 12 months of follow-up, the primary outcome was persistent enteropathic diarrhea, defined as loose or watery stools at all three of the 3-, 6-, and 12-month visits. Preoperative HbA1c, serum albumin, C-reactive protein, coprogram findings, T2DM duration, and antidiabetic regimen were assessed by univariate and multivariable logistic regression, with internal validation by bootstrap resampling. Results Persistent enteropathic diarrhea occurred in 26 of 87 patients (29.9%, 95% CI 20.5–40.6%). Three preoperative variables were independently associated with the outcome: HbA1c (OR 2.28 per 1%, 95% CI 1.53–3.73), steatorrhea on coprogram (aOR 4.36, 95% CI 1.21–16.82), and T2DM duration ≥ 10 years (OR 3.90, 95% CI 1.02–16.16). The multivariable model showed good calibration and discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.863, but HbA1c alone provided comparable performance (AUC 0.827) with no significant additional gain from the full model. At a Youden-optimal HbA1c threshold of ≥ 8.25%, the negative predictive value reached 95.2%. Conclusion In T2DM patients undergoing OAGB, preoperative HbA1c is a robust, clinically accessible single-variable predictor of persistent enteropathic diarrhea at 12 months; coprogram steatorrhea and long-standing diabetes add complementary pathophysiological context. These routine metrics can inform preoperative counseling and risk-adapted postoperative surveillance, and warrant prospective external validation.

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