Glycemia, Insulin Sensitivity, and Secretion Improve 3 Months Post-sleeve Gastrectomy in Youth With Type 2 Diabetes.

IF 3.1 Q2 ENDOCRINOLOGY & METABOLISM Journal of the Endocrine Society Pub Date : 2025-01-28 eCollection Date: 2025-02-04 DOI:10.1210/jendso/bvaf020

Tyler J Dobbs, Melanie G Cree, Alex J Bailey, Amy D Baumgartner, Justin Garrish, Cecelia Diniz-Behn, Laura Pyle, Megan M Kelsey, Amy S Shah, Thomas H Inge, Petter Bjornstad, Kristen J Nadeau

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Abstract

Context: Metabolic bariatric surgery reduces weight in youth with severe obesity; however, its impacts on youth-onset type 2 diabetes (T2D) are unclear.

Objective: We evaluated short-term outcomes in youth with T2D 3 months after vertical sleeve gastrectomy (VSG).

Design: Longitudinal, observational study in the Impact of Metabolic surgery on Pancreatic, Renal, and cardiOVascular hEalth in youth with T2D study (IMPROVE-T2D).

Setting: Academic medical university and children's hospital.

Participants: Fourteen youth with T2D [mean age ± SD 16.8 ± 1.4 years; 50% female, pre-VSG hemoglobin A1c (HbA1c) 6.6 ± 0.2%; diabetes duration 17.6 ± 13.8 months; age at diabetes diagnosis 15.9 ± 1.4 years; body mass index (BMI) 46.7 ± 2 kg/m²].

Interventions: Participants underwent a mixed-meal tolerance test (MMTT), body composition, and indirect calorimetry before and 3 months after VSG.

Main outcomes: Glycemic control (HbA1c, diabetes medications), insulin sensitivity (Matsuda Index, Homeostasis Model of Insulin Sensitivity, oral minimal model), and secretion (C-peptide model).

Results: After VSG, weight and BMI decreased (25.2 ± 5.6 kg [19%], -8.7 ± 2 kg/m² [18%], respectively, P < .001). Body fat decreased (4.5%, P = .012), with reductions of 14.1 ± 5.4 kg of fat mass (P = .005) and 4.5 kg of fat-free mass (P = .034). HbA1c decreased from 6.6 ± 0.2% to 5.7 ± 0.2% (P = .003), with 86% of participants no longer requiring diabetes medications. Glucose was lower throughout the MMTT, with insulin, C-peptide, free fatty acids, glucagon-like peptide-1, and peptide-YY significantly changing postsurgery (P < .05 for all). Insulin sensitivity and insulin secretion rate during the MMTT significantly improved.

Conclusion: Three months post-VSG, youth showed significant improvements in weight, body composition, insulin sensitivity and secretion, and glycemic control, with most no longer requiring diabetes medications.

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2型糖尿病青年胃切除术后3个月血糖、胰岛素敏感性和分泌改善。

背景：代谢性减肥手术可减轻青少年严重肥胖患者的体重；然而，其对青年型2型糖尿病（T2D）的影响尚不清楚。目的：我们评估垂直袖胃切除术（VSG）后3个月青年T2D的短期预后。设计：代谢手术对青年T2D患者胰腺、肾脏和心血管健康影响的纵向观察研究（improved -T2D）。单位：学术型医科大学和儿童医院。参与者：青少年T2D患者14例[平均年龄±标准差16.8±1.4岁；50%女性，vsg前血红蛋白A1c (HbA1c) 6.6±0.2%；糖尿病病程17.6±13.8个月；糖尿病诊断年龄15.9±1.4岁；体重指数（BMI） 46.7±2 kg/m2。干预措施：参与者在VSG前和VSG后3个月分别进行了混合膳食耐量试验（MMTT）、体成分和间接量热测定。主要结局：血糖控制（HbA1c，糖尿病药物），胰岛素敏感性（Matsuda指数，胰岛素敏感性稳态模型，口服最小模型），分泌（c肽模型）。结果：VSG后，体重和BMI分别下降（25.2±5.6 kg[19%]、-8.7±2 kg/m2 [18%], P < 0.001）。体脂减少（4.5%,P = 0.012），脂肪质量减少14.1±5.4 kg (P = 0.005)，无脂质量减少4.5 kg （P = 0.034）。HbA1c从6.6±0.2%降至5.7±0.2% (P = 0.003)， 86%的参与者不再需要糖尿病药物治疗。在整个MMTT过程中，血糖均较低，胰岛素、c肽、游离脂肪酸、胰高血糖素样肽-1和肽- yy在术后发生显著变化（均P < 0.05）。MMTT期间胰岛素敏感性和胰岛素分泌率显著提高。结论：vsg后3个月，青少年在体重、体成分、胰岛素敏感性和分泌、血糖控制方面均有显著改善，大多数不再需要糖尿病药物治疗。

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