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Weight Loss After Sleeve Gastrectomy: Does Type 2 Diabetes Status Impact Weight and Body Composition Trajectories?

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Abstract

Introduction/ purpose:

Sleeve gastrectomy (SG), the most frequently performed bariatric procedure, induces marked weight-loss, but with high inter-individual variability. Since type 2 diabetes (T2D) negatively impacts weight-loss outcomes after Roux-en-Y gastric bypass (RYGB), we herein aimed to evaluate whether and how T2D status may influence weight-loss and body composition changes in individuals with or without T2D after SG.

Material and Methods:

We retrospectively included individuals with obesity operated from SG and prospectively followed at our center: 373 patients including 152 with T2D (40%). All subjects’ clinical characteristics were collected before and during 4 years of follow-up post-SG. Linear mixed models were applied to analyze weight-loss trajectories post-surgery.

Results:

Compared to individuals with obesity but no T2D, those with T2D before SG displayed lower weight-loss at 1 year (21 vs. 27% from baseline, p < 10−3). This difference was accentuated in patients with poorer glucose control (HbA1c > 7%) at baseline. Furthermore, patients with T2D underwent less favorable body composition changes at 1-year post-SG compared to individuals without T2D (% fat mass reduction: 28 vs. 37%, p < 10−3 respectively).

Conclusion:

When undergoing SG, subjects with obesity and T2D who have poor pre-operative glycemic control display reduced weight-loss and less improvement in body composition compared to patients with obesity but without T2D. This result suggests that glycemic control prior to surgery is important to take into account for the outcome of bariatric surgery.

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Acknowledgments

We thank Dr. Florence Marchelli MD (NutriOmics and Human Nutrition Research Center (CRNH Ile de France)) and Rohia Alili (NutriOmics and Human Nutrition Research Center (CRNH Ile de France)) for their contribution to the database and biobanking and Valentine Lemoine for the patient follow-up (ICAN).

Funding

Clinical study was sponsored by the Assistance Publique-Hôpitaux de Paris, and funding of this cohort was obtained by several programs: clinical research contracts for clinical investigation (PHRC 02076 to KC, CRC P050318 to CP, and CRC-FIBROTA to JAW and KC) and the French National Agency of Research ANR (“Investissement d’Avenir” FORCE network (F-Crin)), Metagenopolis grant ANR-11-DPBS-0001, and IHU-ICAN (reference ANR-10-IAHU-05, BARICAN research project). JAW received a reserach grant from bettencourt shueller fondation.

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Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, CRNH Ile de France, Sorbonne Université, Batiment IE3M, 6th floor, 46-83 Boulevard de l’Hôpital, 75013, Paris, France

    Marc Diedisheim, Christine Poitou, Cecile Ciangura, Jean-Michel Oppert, Karine Clément & Judith Aron-Wisnewsky

  2. Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Department of Diabetology, Paris Descartes University, Paris, France

    Marc Diedisheim

  3. Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, INSERM, UMRS U1269, Paris, France

    Christine Poitou, Laurent Genser, Chloé Amouyal & Judith Aron-Wisnewsky

  4. Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne Université, Paris, France

    Laurent Genser & Karine Clément

  5. Assistance Publique-Hôpitaux de Paris, Diabetology Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France

    Chloé Amouyal

  6. Department of Digestive Surgery Department, Saint-Joseph Hospital, Paris, France

    Jean-Luc Bouillot

Authors
  1. Marc Diedisheim
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  2. Christine Poitou
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  3. Laurent Genser
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  4. Chloé Amouyal
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  9. Judith Aron-Wisnewsky
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Contributions

JAW designed the study. CP, CC, JMO, KC, and JAW contributed to patient recruitment and coordinated clinical investigation, patient phenotyping, and sample collection. MD and JAW analyzed data. MD, KC, and JAW wrote the manuscript. LG and JLB operated patients. MD, CP, CC, CA, JMO, KC, and JAW contributed to data presentation and the manuscript.

All authors reviewed the manuscript. JAW is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Judith Aron-Wisnewsky.

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Supplementary Information

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Supplementary Fig. 1

A. BMI values according to baseline HbA1c below or above 7% in individuals with T2D represented as mean ± SD. B. Fat-free mass (in %) values according to baseline HbA1c below or above 7% in individuals with T2D represented as mean ± SD. BMI for body mass index; FFM for Fat mass (% or overall weight) (PNG 210 kb)

High resolution image (TIF 402 kb)

Supplementary Fig. 2

Prevalence of complications post-surgery according to diabetes status. Digestive symptoms include the cumulative prevalence of constipation, diarrhea, abdominal pain and vomiting, which prevalence are also displayed individually. Surgical complication include the cumulative prevalence of fistula, leakage, medio-gastric stenosis, ulcer, hemorrhage, peritonitis, occlusion, abscess, and other (pneumopathy and pyelonephritis). Acid reflux prevalence is displayed on its own. Light gray stands for individuals with T2D and black for those without. ** = p value <0.01 for T2D vs controls. (PNG 202 kb)

High resolution image (TIF 280 kb)

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Diedisheim, M., Poitou, C., Genser, L. et al. Weight Loss After Sleeve Gastrectomy: Does Type 2 Diabetes Status Impact Weight and Body Composition Trajectories?. OBES SURG 31, 1046–1054 (2021). https://doi.org/10.1007/s11695-020-05075-1

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