Background
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 BMI loss (%EBMIL) and clinical metabolic syndrome parameters in patients with T2DM compared to appropriately matched cohort without T2DM.
Methods
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 body mass index (BMI; M=49.3±9.5). Lipids, glucose, hemoglobin A1c, blood pressure (BP), 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 ANOVAs with effect sizes estimates were conducted to compare the two groups.
Results
As expected, T2DM subjects had significantly greater pre-surgical HbA1c, blood glucose, blood pressure and lipid parameters at baseline vs. non-T2DM (all p's<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 to pre-surgical levels (p<0.0001). At 12 months, these values were not different to that of the non-T2DM subjects (p>0.10).
Conclusion
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 twelve months following surgery compared to non-T2DM patients. Further, T2DM surgical patients achieved significant improvement in metabolic syndrome components.