Introduction
Materials and Methods
Study Design
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Patients aged 18–65 years;
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Patients with a body mass index (BMI) of 35–50 kg/m2;
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Patients who had been diagnosed with DM2 at least 6 months prior to the surgery, but who had had the disease for ≤ 5 years, and who were taking oral anti-diabetic medications (≤ 4), but not insulin (the DM2 group); OR an absence of diabetes mellitus (the control group);
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Patients with complications following diabetes mellitus (diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, or diabetic foot ulcers), type 1 diabetes, secondary diabetes, chronic pancreatitis, or oral steroid therapy;
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Patients undergoing a revision procedure;
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Patients with a diagnosis of mental illness that would impede cooperation;
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Alcohol or drug abuse;
Treatment Protocol
Surgical Techniques
Continuous Glucose Monitoring Technique
Outcomes
Statistical Analysis
Results
Characteristics of the Study Group
DM2 | Control | P value | |
---|---|---|---|
n (%) | 16 (50%) | 16 (50%) | n/a |
LSG/LRYGB, n (%) | 6/10 (37.5%/62.5%) | 12/4 (75%/25%) |
0.037
|
Males/females, n (%) | 6/10 (37.5%/62.5%) | 6/10 (37.5%/62.5%) | 0.642 |
Median age, years (IQR) | 46.5 (40–58.5) | 39 (30–44.5) |
0.005
|
Median maximal preoperative BMI, kg/m2 (IQR) | 46.69 (41.43–48.63) | 46.44 (43.06–48.51) | 0.895 |
Median BMI on admission, kg/m2 (IQR) | 43.99 (38.92–47.19) | 43.82 (39.92–45.68) | 0.895 |
Comorbidities: | |||
ASA class 2, n (%) | 10 (62.5%) | 16 (100%) | n/a |
ASA class 3, n (%) | 6 (37.5%) | 0 | |
Non-alcoholic steatohepatitis, n (%) | 0 | 4 (25%) | n/a |
Arterial hypertension, n (%) | 12 (75%) | 6 (37.5%) |
0.037
|
Coronary vascular disease, n (%) | 2 (12.5%) | 0 | n/a |
Peripheral vascular disease, n (%) | 4 (25%) | 0 | n/a |
Obstructive Sleep Apnea, n (%) | 8 (50%) | 2 (12.5%) |
0.027
|
Tobacco smoking, n (%) | 0 | 0 | n/a |
Metabolic panel: | |||
Median HbA1c, % (IQR) | 5.5 (5.4–5.9) | 5.3 (5.2–5.4) | 0.086 |
Median triglycerides, mmol/L (IQR) | 1.76 (1.09–2.27) | 1.52 (1.1–1.85) | 0.364 |
Median HDL, mmol/L (IQR) | 1.2 (0.98–1.49) | 1.14 (0.79–1.19) | 0.275 |
Median LDL, mmol/L (IQR) | 2.86 (2.32–3.22) | 3.03 (2.48–3.56) | 0.415 |
Median total cholesterol, mmol/L (IQR) | 4.65 (4–5) | 4.5 (4–4.8) | 0.870 |
Preoperative, mean daily glucose concentration, mmol/L ± SD | 4.3 ± 1.1 | 4.1 ± 1.2 | 0.622 |
Main Outcomes
LSG | LRYGB | P value | |
---|---|---|---|
Average glucose concentration overtime, mmol/L (IQR) | 5.3 (4.0–8.2) | 4.5 (4.3–4.9) | 0.127 |
% of glucose concentration measurements in targeted compartment (70–120 mmol/L); (IQR) | 50% (9–88%) | 75% (69–80%) | 0.513 |
% of glucose concentration measurements below targeted compartment (70–120 mmol/L); (IQR) | 1% (0–5%) | 25% (10–30%) | 0.127 |
% of glucose concentration measurements above targeted compartment (70–120 mmol/L); (IQR) | 11% (0–91%) | 1% (0–5%) | 0.264 |
Low glucose concentration events, n ± SD | 5 ± 5.59 | 11.6 ± 5.36 |
0.035
|
Average time of low glucose event, min (IQR) | 110 (0–439) | 262 (241–511) |
0.049
|
Estimated HbA1c%, % (IQR) | 5% (4.1–6.7%) | 4.65% (4.05–6.45%) | 0.603 |
Mean daily glucose concentration on day 1, mmol/L ± SD | 4.3 ± 0.9 | 4.4 ± 1.2 | 0.805 |
Mean daily glucose concentration on days 2–3, mmol/L ± SD | 5.1 ± 0.5 | 5.0 ± 1.0 | 0.876 |
Mean daily glucose concentration on days 4–6, mmol/L ± SD | 5.8 ± 2.4 | 4.2 ± 0.5 |
0.005
|
Mean daily glucose concentration on days 7–10, mmol/L ± SD | 6.0 ± 1.8 | 3.0 ± 1.5 |
< 0.001
|
LSG | LRYGB | P value | |
---|---|---|---|
Average glucose concentration overtime, mmol/L (IQR) | 4.5 (4.2–5.2) | 4.4 (4.0–4.9) | 0.488 |
% of glucose concentration measurements in targeted compartment (70–120 mmol/L); (IQR) | 70.5% (43–77%) | 63% (60–66%) | 0.329 |
% of glucose concentration measurements below targeted compartment (70–120 mmol/L); (IQR) | 19.5% (9–50%) | 31% (22–20%) | 0.624 |
% of glucose concentration measurements above targeted compartment (70–120 mmol/L); (IQR) | 7.5% (3–14%) | 6% (0–12%) | 0.736 |
Low glucose concentration events, n ± SD | 14.8 ± 5.54 | 12.5 ± 4.04 | 0.357 |
Average time of low glucose event, min (IQR) | 240.5 (166–289) | 207 (165–249) | 0.329 |
Estimated HbA1c%, % (IQR) | 4.45% (4.3–4.9%) | 4.85% (4.7–5%) | 0.084 |
Mean daily glucose concentration on day 1, mmol/L ± SD | 4.2 ± 1.3 | 3.9 ± 1.2 | 0.592 |
Mean daily glucose concentration on days 2–3, mmol/L ± SD | 5.3 ± 0.8 | 4.3 ± 1.6 | 0.107 |
Mean daily glucose concentration on days 4–6, mmol/L ± SD | 4.2 ± 0.6 | 4.5 ± 0.7 | 0.706 |
Mean daily glucose concentration on days 7–10, mmol/L ± SD | 3.9 ± 0.6 | 4.7 ± 0.8 | 0.202 |
LSG | LRYGB | P value | |
---|---|---|---|
Average glucose concentration overtime, mmol/L (IQR) | 4.7 (4.2–5.3) | 4.5 (4–4.9) | 0.230 |
% of glucose concentration measurements in targeted compartment (70–120 mmol/L); (IQR) | 67% (43–77%) | 69% (60–80%) | 0.608 |
% of glucose concentration measurements below targeted compartment (70–120 mmol/L); (IQR) | 9% (6–50%) | 25% (10–40%) | 0.286 |
% of glucose concentration measurements above targeted compartment (70–120 mmol/L); (IQR) | 8% (3–14%) | 1% (0–12%) | 0.075 |
Low glucose concentration events, n ± SD | 11.6 ± 7.2 | 11.9 ± 4.9 | 0.894 |
Average time of low glucose event, min (IQR) | 196 (110–289) | 249 (195–511) | 0.254 |
Estimated HbA1c%, % (IQR) | 4.6% (4.3–5%) | 4.8% (4.4–5%) | 0.551 |
Mean daily glucose concentration on day 1, mmol/L ± SD | 4.2 ± 1.1 | 4.3 ± 1.2 | 0.975 |
Mean daily glucose concentration on days 2–3, mmol/L ± SD | 5.3 ± 0.7 | 4.8 ± 0.9 | 0.305 |
Mean daily glucose concentration on days 4–6, mmol/L ± SD | 4.8 ± 1.6 | 4.3 ± 0.6 | 0.263 |
Mean daily glucose concentration on days 7–10, mmol/L ± SD | 4.6 ± 1.5 | 3.5 ± 1.4 |
0.013
|