Abstract
Geography is one of the key drivers of the significant variation in the etiopathogenic profile and prevalence of type 2 diabetes mellitus (T2DM) and obesity, therefore geographically based data are fundamental for implementing the appropriate interventions. Presently, the selection criteria of T2DM and obesity patients for laparoscopic sleeve gastrectomy (LSG) have not reached a worldwide consensus—highlighting the need for sharing experts’ guidance in the preoperative evaluation, choice of the interventional procedure, perioperative management and patient long-term care. The aim of the current study was to evaluate the impact of LSG on T2DM (T2DM) remission in Romanian obese male patients, based on a multiparametric, prospective investigation. We have conducted a randomized controlled study on 41 obese male participants with the body mass index (BMI) ≥ 30 kg/m2, aged 30–65 years, which were randomly divided in two study groups: one receiving conventional treatment and the second undergoing LSG. The clinical and anthropometrical parameters, resting metabolic rate, general biochemical status, adipocytes profile, gastrointestinal hormones levels, proinflammatory, oxidant and antioxidant profiles were determined at three time points: V1 (baseline), V2 (after six months) and V3 (after 12 months). Glycated hemoglobin (HbA1c), blood glucose levels, BMI, weight, visceral fat level, HDL-cholesterol, incretin hormones, proinflammatory and the oxidative stress status were significantly improved in the LSG versus conventional treatment group. This is the first study reporting on the evaluation of metabolic surgery impact on Romanian obese male patients with T2DM. Our results confirm that LSG could contribute to T2DM remission in patients with diabesity, but this beneficial effect seems to be critically influenced by the duration of T2DM rather than by the obesity status. Our results show that, in addition to the parameters included in the prediction algorithm, the proinsulin levels, proinsulin/insulin ratio and the visceral fat percentage could bring added value to the assessment of metabolic status.
Highlights
We are facing a worldwide epidemic of obesity and type 2 diabetes mellitus (T2DM)—often linked together, as suggested by the currently used term of “diabesity” [1]
The patients included in this study were relatively young, with a mean age for conventional treatment group of 48.7 ± 6.8 years and of 46 ± 5.9 for the laparoscopic sleeve gastrectomy (LSG) group, with morbid obesity and poor metabolic control for both groups, despite the relatively short duration of T2DM, i.e., 6.3 ± 4.5 years for the conventional group and 5.4 ± 2.9 for the LSG one
The results reported in the literature are confirmed by the present study, showing a statistically significant decrease in glycated hemoglobin (HbA1c), blood glucose, body mass index (BMI), weight, visceral fat level, HDL-cholesterol and incretin hormones levels in LSG patients compared with the conventional treatment group [23]
Summary
We are facing a worldwide epidemic of obesity and T2DM—often linked together, as suggested by the currently used term of “diabesity” [1]. The excessive adipose tissue is associated with a chronic proinflammatory condition, contributing to the occurrence of insulin resistance, a fundamental pathogenic mechanism involved in the development of T2DM. Current data show that the number of “diabesity” cases is alarmingly increasing in Romania, with nearly 2 out of 10 young people being overweight [3,4] and 20% of the entire population with obesity developing T2DM. According to the PREDATORR (Prevalence of T2DM and preT2DM in the adult Romanian population) study conducted in 2016, in about 48% of cases, T2DM is associated with morbid obesity [4]
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