P48 Metabolic results after bariatric surgery in patients with type 2 diabetes and obesity

Abstract

Introduction: In type 2 diabetic and obese patients it is frequently difficult to achieve weight and metabolic control goals with lifestyle changes and pharmacotherapy and sometimes accomplished by bariatric surgery (BS).

Objectives: to evaluate metabolic effects of BS in a diabetic and obese population.

Materials and methods: 56 patients were evaluated preoperative and postoperative (BS). Personal background, anthropometric measurements, blood pressure, body mass index (BMI), hemogram, hepatogram, glycemia, lipid profile, HbA1c and renal function were analyzed.Statistical analysis: Student’s and Mann-Whitney-Wilcoxon tests were applied. Spearman correlation coefficient was calculated. Values expressed in average ± standard deviation. Significant p< 0,05.

Results: The sample consisted of 35 female and 21 male with a mean age of 52±9,6. One anastomosis gastric bypass (OAGB) was performed in 29 patients and laparoscopic Roux en-Y gastric bypass (LRYGB) in 27. Pre and postoperative data was analyzed. Postoperative data with a time lapse between 3 to 79 months, average of 31.6. In the preoperative period 52% received insulin, 77% metformin, 23% IDPP4, 100% antihypertensive drugs and 69% lipid lowering therapies while in the postoperative group only 7% were still treated with insulin, 14% metformin, 11% IDPP4, 54% antihypertensive drugs and 31% lipid lowering therapies. During the follow up BMI decreased from 43,87±9,99 kg/m2 in preoperative period to 29,48±5,82 kg/m2 in postoperative period (p<0,0001). There were not significant differences in blood pressure. Regarding metabolic parameters a significant difference was observed: Glycemia (mg/dl) 149±58 vs 101±21(p<0,0001); HbA1c 8,14±2,5% vs 5,86±1,09(p<0,0001); Triglycerides (TG) (mg/dl)159±68 vs 106±60 (p< 0,0001); TG/HDL: 4,11±2 vs 2,14±1,45 (p< 0,0001); HDL(mg/dl) 41±10 vs 53±13(p<0,0001); no HDL(mg/dl) 140±39 vs 122±37 (p 0,007); uric acid 5,44±1,47 vs 4,74±1,04(p 0,0004). There was significant correlation between
time in months after surgery and TG (r 0,27 p 0,04) TG/HDL (r 0,34 p 0,01) levels. Statistical significant reduction was found in favor of OAGB vs LRYGB regard of BMI (p 0,02), TG (p 0,01), total cholesterol (p 0,01) y no HDL (p 0,03). Hypoglycemia was found in 3,5% post BS and anemia in 14,28%.

Conclusions: As seen by other authors we found enhancement with BS in BMI, metabolic parameters and less use of medications. There were not significant differences in blood pressure levels.