The headline trial: BARI-OPTIMISE + SURPASS
BARI-OPTIMISE (Mok Lancet D&E 2024) for post-bariatric regain; SURPASS-1 through SURPASS-5 (Frias 2021–2022) for tirzepatide in T2D
BARI-OPTIMISE 2024; SURPASS series 2021–2022
Patients with weight regain after bariatric surgery AND persistent or recurrent T2D respond well to GLP-1 or GLP-1/GIP. BARI-OPTIMISE: 8.8 percent mean weight loss with semaglutide versus 0.5 percent placebo in post-bariatric regain. SURPASS: tirzepatide produced A1c reductions of 1.5 to 2.5 points and weight loss of 7 to 11 kg in T2D, with similar efficacy in patients with prior bariatric surgery in sub-analyses.
Trial enrollment criteria
- History of bariatric surgery at least 18 months prior with documented weight nadir
- Documented weight regain (typically at least 10 percent regain from nadir)
- Current T2D with A1c at least 6.5 percent
- Current BMI greater than or equal to 30 (or 27 with comorbidity)
Does this trial apply to you?
Post-bariatric patients with persistent or recurrent T2D are a defensible PA case under either indication. File under T2D (E11.x) with bariatric history and BMI as supporting context, OR under obesity-with-comorbidity (E66.x + E11.x) where both indications stack. The bariatric surgeon co-signing strengthens the submission.
What to ask your prescriber
- Type and date of prior bariatric surgery, weight nadir, current weight
- Current A1c, fasting glucose and any prior anti-diabetic medication trials
- Whether bariatric surgeon co-sign is available
- Nutritional status: B12, iron, vitamin D, protein adequacy
Editorial notes
- Slow titration is important; post-bariatric patients often experience amplified GI side effects.
- Continue post-bariatric multivitamin and micronutrient monitoring; rapid weight loss can mask deficiencies.
- Persistent T2D after bariatric surgery is increasingly recognized as a distinct phenotype warranting GLP-1 RA rather than a return to insulin escalation.
Clinical trials for Post-bariatric weight regain with persistent type 2 diabetes
Or browse the full GLP-1 clinical trials directory, filterable by condition, state and phase.
Take it to your prescriber: PA letter templates
Editable prior-authorization letter templates that cite the registration trial above. Pick the plan your prescriber will submit to, copy the template, fill in the patient-specific findings and have your clinician sign and submit.
Not seeing your plan? The full PA letter librarycovers 20 plans × 10 indications = 200 templates. The appeal letter library handles denials.
Drug profiles
Other GLP-1 conditions
Editorial provenance
Editorial review by John, Editor on 2026-05-23, against BARI-OPTIMISE + SURPASS (BARI-OPTIMISE 2024; SURPASS series 2021–2022). We do not yet have a credentialed medical reviewer on staff (actively recruiting). This page summarises public registration-trial data and FDA labeling. It is not clinician-authored medical advice.
Disclaimer
Educational summary of published registration trial data. Not medical advice. Not a substitute for evaluation by a treating clinician. Trial-level results do not guarantee individual outcomes. Discuss eligibility, contraindications, dose adjustments and drug interactions with your prescriber. We do not have a credentialed medical reviewer on staff yet (actively recruiting); the content below is editor-written from public registration-trial publications and FDA labeling, not clinician-authored medical advice.