A 24-Month Prospective Study of the Effects of Sleeve Gastrectomy on Glucose Homeostasis in Youth.

Background

Metabolic and bariatric surgery (MBS) results in significant changes in weight and body composition, along with glucose homeostasis improvement and type 2 diabetes resolution. In youth, sleeve gastrectomy (SG) is the most frequently performed MBS. Long-term studies assessing the duration over which glucose homeostasis parameters improve after SG are sparse.

Objective

To examine the duration over which SG impacts glucose homeostasis in youth.

Methods

This 24-month prospective study enrolled 65 youth (49 females) with moderate-severe obesity (mean age 18.0 ± 0.3 years). A total of 28 underwent SG, while 37 non-surgical (NS) participants received routine lifestyle counseling. At baseline, 12- and 24-month follow-up visits, HbA1c, and fasting and post-prandial insulin and glucose levels at 15, 30, 60, 90, and 120 min following a mixed meal tolerance test were obtained, and body composition was assessed.

Results

At baseline, SG vs. NS had higher weight, body mass index (BMI) and percent fat mass (p ≤ 0.019), but did not differ for glucose homeostasis parameters. Over 24 months, reductions in weight-related parameters were noted in SG vs. NS (p ≤ 0.0001). Over 12 and 24 months, improvements occurred in HbA1c, fasting insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and the Matsuda index in SG vs. NS (p ≤ 0.002). However, the between-group difference for changes in glucose homeostasis parameters between 12 and 24 months was not significant.

Conclusions

Improvements in glucose homeostasis occur mostly in the first year following SG, with subsequent stabilization of these measures.