Obes Surg: Associated with less weight loss after bariatric surgery in people with type 2 diabetes

Background: Bariatric surgery is the most effective treatment to achieve significant and sustained weight loss, consistently inducing long-term remission
of the disease in patients affected by type 2 diabetes mellitus (T2D).
Several changes have occurred after bariatric surgery, such as increased GLP-1 secretion, marked inhibition of plasma branched-chain amino acids, increased circulating bile acids, and changes in the gut microbiota, which are all thought to contribute to good metabolic outcomes
.
Recently, however, in an excellent study by Yoshino and colleagues, matched weight loss induced by gastric bypass (RYGB) or diet alone affected a variety of metabolic outcomes, such as liver, muscle, and adipose tissue insulin sensitivity; β cell function; Metabolic reactions to mixed meals; and assess 24-hour plasma glucose, insulin, and free fatty acid profiles
.
They found that diet and RYGB produced similar metabolic benefits on the main physiological factors that regulate glycemic control, suggesting that the beneficial metabolic effects of bariatric surgery can be attributed solely to weight loss itself and not to any effects
unrelated to weight loss.
Since lifestyle interventions are often unsuccessful for long-term weight loss, the clinical utility of bariatric surgery is unquestionable
.

It is now well established that the mechanisms leading to weight loss after bariatric surgery cannot be fully attributed to a decrease in nutrient intake and mild absorption of
nutrients.
A number of other mechanisms are also involved, which include increased secretion of enterogenic sex hormones, having anorexia, changing dietary patterns, bile acids and microbiota adaptation
.
However, even after bariatric surgery, some patients only lose a small amount of excess weight, which represents treatment failure
.
Therefore, identifying predictors of outcome after bariatric surgery may help identify ideal candidates for this intervention, but may also help set realistic goals
for weight loss outcomes.

Several studies now assess the preoperative determinants
of weight loss after bariatric surgery.
Among them, age and preoperative body mass index are well-known predictors of subsequent weight loss
.
Postprandial hypoglycemia is a common complication after bariatric surgery, and in a recent study, we found that after bariatric surgery, the occurrence of postprandial hypoglycemia is associated
with weight loss after bariatric surgery.
Although other studies have failed to replicate the independent effects of T2D on weight loss after bariatric surgery, comorbidities present prior to the intervention, including the presence of T2D, have been reported to be risk factors
for worse outcomes after bariatric surgery.

Objective: To assess whether the presence of type 2 diabetes mellitus (T2D) at baseline and remission of T2D after bariatric surgery affected the outcome of
weight loss.

Methods: The data of 312 morbidly obese patients who underwent continuous bariatric surgery were analyzed
.
Patients who underwent RYGB (77%) or sleeve gastrectomy (23%) had their weight followed for 1, 2, 3, 4, and 5 years at regular outpatient follow-up (N = 269, 312, 210, 151, 105 per year, respectively).

Assess T2D mitigation according to ADA criteria
.

Results: Across the dataset, 92 patients were affected
by T2D.
Patients with T2D were older than those without T2D (52±9 years versus 45±11 years, p < 0.
0001), but there were no differences
in baseline body mass index, sex, and type of intervention received 。 We found that the presence of baseline T2D was associated with smaller weight loss at 1, 2, 3, 4, and 5 years after bariatric surgery (δ body mass index at 2 years: 13.
7 [7.
7]vs 16.
4 [7.
3] kg/m2; At 5 years, patients with T2D disease and non-T2D disease were 12.
9 [8.
8] and 16.
3 [8.
7] kg/m2, respectively, and both < 0.
05).

When patients with T2D were classified as remitters and non-remitters, the weight loss of non-remitters was significantly smaller than that of remitters (δ body mass index at 2 years: 11.
8 [6.
3] vs 15.
4 [7.
8] kg/m2; After 5 years: 8.
0 [7.
1] vs 15.
0 [7.
2] kg/m2, non-sender vs.
sender, p < 0.
05).

Fig.
1 In the pooled data, age, baseline body mass index (A) and age (B) were associated
with δ body mass index follow-up at 2 years.
Data is displayed as RYGB (black circle) or LSG (gray circle)

Table 1 Correlation coefficients for age and baseline BMI effects, or 95% confidence intervals for RYGB effects, T2D loss, and T2D remission at 1, 2, 3, 4, and 5 years of follow-up

Fig.
2 The histogram shows the average δ body mass index (A)
at 2 years of follow-up of T2D and non-T2D patients.
The histogram shows the mean δ body mass index (B)
of T2D patients in remission and non-remission at 2 years of follow-up.
Baseline glycosylated hemoglobin was negatively associated with δ body mass index at 2 years follow-up, but this association was mainly driven by non-emitters (C); * p < 0.
05

Table 2 Weight loss results
in three groups.
*

Figure 3 Body mass index progression
from baseline to multi-year follow-up.
The black line represents non-remitters, the gray line represents remitters, and the dotted line represents patients
without T2D.
#p < 0.
05 between remitters and patients without T2D < 0.
05, * between non-remitters and patients without T2D p < 0.
05
.

Conclusions: T2D was associated with less weight loss after bariatric surgery, especially in
subjects who did not achieve diabetic remission.

Original source:

Rebelos E, Moriconi D, Honka MJ,et al.
Decreased Weight Loss Following Bariatric Surgery in Patients with Type 2 Diabetes.
Obes Surg 2022 Nov 02