Marc Diedisheim1,2, Christine Poitou1,3, Laurent Genser3,4, Chloé Amouyal3,5, Jean-Luc Bouillot6, Cecile Ciangura1, Jean-Michel Oppert1, Karine Clément1,4, Judith Aron-Wisnewsky7,8. 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. 2. Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Department of Diabetology, Paris Descartes University, Paris, France. 3. Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, INSERM, UMRS U1269, Paris, France. 4. Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne Université, Paris, France. 5. Assistance Publique-Hôpitaux de Paris, Diabetology Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France. 6. Department of Digestive Surgery Department, Saint-Joseph Hospital, Paris, France. 7. 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. judith.aron-wisnewsky@aphp.fr. 8. Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, Sorbonne Université, INSERM, UMRS U1269, Paris, France. judith.aron-wisnewsky@aphp.fr.
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.
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.
Entities:
Keywords:
Bariatric surgery; Body composition; Obesity; Sleeve gastrectomy; Type 2 diabetes; Weight-loss
Authors: Anita P Courcoulas; Nicholas J Christian; Steven H Belle; Paul D Berk; David R Flum; Luis Garcia; Mary Horlick; Melissa A Kalarchian; Wendy C King; James E Mitchell; Emma J Patterson; John R Pender; Alfons Pomp; Walter J Pories; Richard C Thirlby; Susan Z Yanovski; Bruce M Wolfe Journal: JAMA Date: 2013-12-11 Impact factor: 56.272
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