The influences of bariatric surgery on hemoglobin A1c in a sample of obese patients in Saudi Arabia

Abstract

BackgroundAlthough the frequency of surgical weight loss interventions has increased in Saudi Arabia, literature describing the clinical outcomes of bariatric surgery in Saudi Arabia is limited. This study aimed to assess whether weight loss intervention improves hemoglobin A1c (HbA1c) in obese patients and to identify its associated factors.Patients and methodsA retrospective study was carried out on 318 patients with obesity class 1 or higher (body mass index [BMI] ≥ 30 kg/m2) who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass at King Abdulaziz Medical City in Riyadh, Saudi Arabia, between January 1, 2001 and March 31, 2017. Preoperatively and 12 months postoperatively, characteristics of patients were collected. BMI reduction was calculated, based on which patients were divided into three groups (0–9, 10–14, and >14 kg/m2).ResultsThe postoperative HbA1c was 5.83±0.9, while the baseline level was 6.74±2.1 (P=0.001). Fifty-eight of the 318 patients had diabetes. We observed significantly higher HbA1c in diabetic than in non-diabetic patients preoperatively, whereas an insignificantly different HbA1c was observed postoperatively. Among those who had minimal reduction in BMI (0–9 kg/m2), we observed significantly higher HbA1c in diabetic than in non-diabetic patients, whereas among those who had large reduction in BMI (10–14 kg/m2) and (>14 kg/m2), we observed insignificant differences in HbA1c in diabetic than in non-diabetic patients.ConclusionBeing a diabetic patient was related to a significant reduction in HbA1c levels postoperatively. The study suggests that the reduction in HbA1c levels could be modified by BMI, wherein greater reduction in BMI leads to greater reduction in HbA1c levels.

Effect of Bariatric Surgery on Glycaemic Control in King Fahad Hospital

“…Previous literature reported a substantial reduction of BMI associated with HbA1c reduction within 12 months, and we noted similar results, but within 10 months [ 23 , 25 , 26 ]. Lee et al (2009) found remission of diabetes in poorly controlled patients with a 22.8% reduction in HbA1c after LSG.…”

“…This effect is related to decreased insulin resistance due to calorie restriction [ 27 ]. A study done by Ahmed et al (2018) reported that patients with BMI >40 kg/m 2 had a significant reduction in weight within 12 months after LSG, with a 25% reduction of weight postoperatively [ 23 ]. Also, Ahmed et al (2018) and Sucandy et al (2013) reported a significant postoperative reduction of BMI and improved glycemic control at one year following LSG [ 25 , 26 ].…”

“…In Saudi Arabia, there is a paucity of studies that document the outcome of bariatric surgeries on weight reduction and HbA1c. Ahmed et al (2018), concluded that there is a substantial reduction in HbA1c between preoperative and postoperative periods within 12 months among obese patients who underwent LSG, and it was explained by the achieved reduction of BMI [ 23 ]. Because of its effectiveness in weight loss, LSG became the preferable procedure in Saudi Arabia.…”

Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia

“…Bariatric surgery results in a greater and more durable weight loss than the best available nonsurgical interventions for obesity, regardless of the type of bariatric procedures used [6]. Beyond weight loss, the effect of bariatric surgery extends to enhancing glycemic control [7,8], improving lipid profile [9], controlling elevated blood pressure [10], achieving type 2 diabetes mellitus remission and metabolic syndrome resolution [11,12], alleviating obstructive sleep apnea [13], augmenting renal functions [14], treating nonalcoholic fatty liver disease [15], improving quality of life and body image [16], improving fertility and sexual health [17,18], lowering cardiovascular events [19], decreasing cancer risks [20], prolonging long-term survival [19], and decreasing medical cost [21].…”

Sensitivity of DiaRem Scoring System in Predicting Type Two Diabetes Mellitus Resolution After Bariatric Surgery in Qassim Region

“…A retrospective study in Saudi Arabia was carried out on 318 obese patients who underwent either LSG or RYGB, 58 of whom were diabetic. This study aimed to measure the percentage of HbA1c reduction after bariatric surgery on the two groups; the authors found that the target of HbA1c 6.5% or less was observed in 62.5% of diabetic patients and 97.1% of the non-diabetic patients [ 12 ]. Another study was done in Saudi Arabia on 56 morbidly obese patients with T2DM; a follow-up of 30 months after LSG showed a resolution of diabetes in 22%, 54%, and 90% in the third, sixth, and 12th months postoperatively, respectively [ 13 ].…”