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Abstract Details
Glycemia, Insulin Sensitivity, and Secretion Improve 3 Months Post-sleeve Gastrectomy in Youth With Type 2 Diabetes.
Dobbs, Tyler J (TJ);Cree, Melanie G (MG);Bailey, Alex J (AJ);Baumgartner, Amy D (AD);Garrish, Justin (J);Diniz-Behn, Cecelia (C);Pyle, Laura (L);Kelsey, Megan M (MM);Shah, Amy S (AS);Inge, Thomas H (TH);Bjornstad, Petter (P);Nadeau, Kristen J (KJ);
CONTEXT: Metabolic bariatric surgery reduces weight in youth with severe obesity; however, its impacts on youth-onset type 2 diabetes (T2D) are unclear.
OBJECTIVE: We evaluated short-term outcomes in youth with T2D 3 months after vertical sleeve gastrectomy (VSG).
DESIGN: Longitudinal, observational study in the Impact of Metabolic surgery on Pancreatic, Renal, and cardiOVascular hEalth in youth with T2D study (IMPROVE-T2D).
SETTING: Academic medical university and children's hospital.
PARTICIPANTS: Fourteen youth with T2D [mean age ± SD 16.8 ± 1.4 years; 50% female, pre-VSG hemoglobin A1c (HbA1c) 6.6 ± 0.2%; diabetes duration 17.6 ± 13.8 months; age at diabetes diagnosis 15.9 ± 1.4 years; body mass index (BMI) 46.7 ± 2 kg/m].
INTERVENTIONS: Participants underwent a mixed-meal tolerance test (MMTT), body composition, and indirect calorimetry before and 3 months after VSG.
MAIN OUTCOMES: Glycemic control (HbA1c, diabetes medications), insulin sensitivity (Matsuda Index, Homeostasis Model of Insulin Sensitivity, oral minimal model), and secretion (C-peptide model).
RESULTS: After VSG, weight and BMI decreased (25.2 ± 5.6 kg [19%], -8.7 ± 2 kg/m [18%], respectively, < .001). Body fat decreased (4.5%, = .012), with reductions of 14.1 ± 5.4 kg of fat mass ( = .005) and 4.5 kg of fat-free mass ( = .034). HbA1c decreased from 6.6 ± 0.2% to 5.7 ± 0.2% ( = .003), with 86% of participants no longer requiring diabetes medications. Glucose was lower throughout the MMTT, with insulin, C-peptide, free fatty acids, glucagon-like peptide-1, and peptide-YY significantly changing postsurgery ( < .05 for all). Insulin sensitivity and insulin secretion rate during the MMTT significantly improved.
CONCLUSION: Three months post-VSG, youth showed significant improvements in weight, body composition, insulin sensitivity and secretion, and glycemic control, with most no longer requiring diabetes medications.
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