Equivalent Weight Loss with Marked Metabolic Benefit Observed in a Matched Cohort with and Without Type 2 Diabetes 12 Months Following Gastric Bypass Surgery
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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.
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.
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).
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.
KeywordsType 2 diabetes mellitus Morbid obesity Roux-en-Y anastomosis Weight loss Metabolic syndrome Gastric bypass Bariatric surgery Insulin
Body mass index
Fasting blood glucose
International Classification of Diseases ninth revision
Laparoscopic Roux-en-Y gastric bypass
Type 2 diabetes mellitus
This work was supported by a grant from the Ray A. and Robert L. Kroc Summer Research Fellowship (KY). SRK receives grant support by American Diabetes Association and both SRK and PRS are supported by National Institutes of Health RO1 DK089547-01 NIDDK/NIH.
SRK and PRS disclose grant support from Ethicon Endo-surgery, Inc. PRS is also on the scientific advisory board of SurgiQuest, Barosense, and Surgical Excellence; acts as consultant for C.R. Bard, Ethicon Endo-surgery, Inc., Baxter Healthcare, Stryker, Cardinal Health, and W.L. Gore and Associates, Inc.; and acts in a fiduciary capacity to the MISS Surgery Symposium, Physician Review of Surgery and RemedyMD. LJH discloses grant support from Nutrisystems, Inc. The other authors (KY and VG) have nothing to disclose.