Equivalent weight loss with marked metabolic benefit observed in a matched cohort with and without type 2 diabetes 12 months following gastric bypass surgery.
BACKGROUND
Bariatric surgery results in dramatic weight loss and improves metabolic syndrome and type 2 diabetes (T2DM). However, previous studies have noted that morbidly obese patients with T2DM experience less weight loss benefits than non-diabetic patients following bariatric surgery. We sought to determine longitudinal effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) on percent excess body mass index (BMI) loss (%EBMIL) and clinical metabolic syndrome parameters in patients with T2DM compared with appropriately matched cohort without T2DM.


METHODS
Retrospective cohort analysis of T2DM patients (n = 126) to non-T2DM patients (n = 126) matched on age (M = 48.1 ± 9.5), sex (81 % female), race (81 % Caucasian), and pre-surgical BMI (M = 49.3 ± 9.5). Lipids, glucose, hemoglobin A1c, blood pressure, co-morbidities of obesity, medications for co-morbidities, and T2DM medications were collected at baseline, 6 months and 12 months post-surgery. %EBMIL was collected at 1, 3, 6, 9, and 12 months post-surgery. One-way analyses of variance with effect sizes estimates were conducted to compare the two groups.


RESULTS
As expected, T2DM subjects had significantly greater pre-surgical HbA1c, blood glucose, blood pressure, and lipid parameters at baseline vs. non-T2DM (all p values of<0.05). At 1, 3, 6, 9, and 12 months after LRYRB, both groups had similar reduction in %EBMIL (p > 0.10). At 6 months, there was a significant reduction in HbA1c, blood glucose, and lipid in the T2DM cohort compared with pre-surgical levels (p < 0.0001). At 12 months, these values were not different to that of the non-T2DM subjects (p > 0.10).


CONCLUSIONS
When matched on appropriate factors associated with weight loss outcomes, severely obese patients with T2DM have similar post-LRYGB weight loss outcomes in the first 12 months following surgery compared with non-T2DM patients. Furthermore, T2DM surgical patients achieved significant improvement in metabolic syndrome components.
Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
Kathleen
K
Yip
Leslie
L
Heinberg
Victoria
V
Giegerich
Philip R
PR
Schauer
Sangeeta R
SR
Kashyap
D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D010535:Laparoscopy; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human