Severe Insulin Resistance Improves Immediately After Sleeve Gastrectomy

Rahul Sharma,Joumana T Chaiban,Chandra Hassan

doi:10.1177/2324709615625309

Abstract

Introduction. Obese individuals exhibit insulin resistance often leading to adverse health outcomes. When compared with intensive medical therapy, bariatric surgery has shown better outcomes mainly in terms of insulin resistance and glycemic control. Using the Homeostasis Model Assessment of insulin resistance (HOMA-IR), we report herein a case illustrating a drastic improvement in severe insulin resistance after sleeve gastrectomy in the immediate postoperative period. Case Report. A patient with long-standing history of morbid obesity, type 2 diabetes, obstructive sleep apnea, hypertension, and severe insulin resistance (requiring approximately 2 units of insulin per kg per day) was enrolled in the medical weight management program for 6 months during which he lost 40 lbs and his insulin requirements decreased. He then underwent a sleeve gastrectomy and did not require insulin therapy as of postoperative day 1. His HOMA-IR improved by about 76% between day 1 and day 14 postoperatively. Conclusion. Sleeve gastrectomy leads to a drastic improvement in severe insulin resistance as early as the first postoperative day.

Highlights

Obese individuals exhibit insulin resistance often leading to adverse health outcomes
We present the case of a morbidly obese patient who underwent sleeve gastrectomy with subsequent immediate improvement of his severe insulin resistance
Rao et al[7] found an average improvement of 33.48% in insulin resistance as early as 1 to 2 weeks after surgery with a preoperative Homeostasis Model Assessment of insulin resistance (HOMA-IR) range of 4.12 to 11.33. This is the first case demonstrating an earlier drastic improvement in HOMA-IR after sleeve gastrectomy compared with the published literature

Summary

Introduction

Obese individuals exhibit insulin resistance often leading to adverse health outcomes. Obesity and sedentary lifestyle are major contributors to insulin resistance and type 2 diabetes (T2DM), and weight loss results in their improvement.[1] Bariatric surgery, the most effective available tool for substantial and sustained weight loss,[2] results in rapid amelioration of insulin resistance independent of such a weight loss early in the postoperative period.

Results

Conclusion