IMPACT OF BARIATRIC SURGERY ON INSULIN RESISTANCE IN PATIENTS ATTENDING SUEZ CANAL UNIVERSITY HOSPITALS

Abstract

Background: Obesity is considered a serious epidemic and one of the leading global causes of preventable deaths.

Aim: This prospective observational study aimed to assess the impact of bariatric surgery on insulin resistance in obese patients attending Suez Canal university hospitals so helping in promotion of management of insulin resistance and type 2 diabetes mellitus.

Patients and Methods: This prospective observational study included 40 patients with age over 18 years, BMI ≥35 (kg/m2) and HOMA-IR ≥2 who underwent bariatric surgery during the period from July 2021 to January 2023. Our data obtained by history taking, examination and investigations; including measurement of fasting insulin, fasting blood sugar, HbA1C, TNF- α and calculated HOMA-IR before and after 3 months of the surgery.

Results: The mean age of our patients was 39.95 ± 9.68 years, the majority of the patients (92.5%) were females, Most of the patients (80%) were married, (67.5%) received high level of education, 45% of the patients were diabetic, 17.5% were prediabetic and 37.5% were non-diabetic. There were 32.5% of our patients received oral treatment and only 2.5% (1 patient) was on insulin therapy for diabetes, 95% of our patients had laparoscopic sleeve gastrectomy and only 5 % patients had mini-gastric bypass. After 3 months of the surgery, the mean weight reduced from 135.27± 23.01 to 109.78±19.99 kg, the mean BMI was 50.93± 8.11 decreased to 41.35±7.10 kg/m². The mean HbA1C was 6.48 ± 1.10 % and improved to be 5.55 ± 0.75%. Mean fasting blood sugar decreased from 119.28± 38.93 mg/dl to 77.45±14.20 mg/dl. Mean fasting insulin level decreased from 25.81± 18.92 mcU/mL before operation to 10.27± 6.46 mcU/mL. Mean HOMA-IR decreased from 7.70 ± 7.06 to 1.98 ± 1.34 and mean TNF-α level was 145.32 ± 58.96 and reduces to 117.86 ± 27.43 postoperatively. Our study revealed that there was statistically significant decrease in weight and BMI (P < 0.0001), significant improvement in the metabolic parameters of the patients (P < 0.0001) including (HbA1C, HOMA-IR, fasting insulin, fasting blood sugar), and a significant decrease (P < 0.0001) in the measured inflammatory marker (TNF- α) after 3 months of the surgery.

Conclusion: Bariatric surgery representing an effective option for obese patients for marked weight loss with significant improvement in insulin sensitivity either in diabetic, prediabetic and non-diabetic patients which helps in eliminating the predisposing factors of prediabetic and non-diabetic patients for developing diabetes and management of T2DM and prevention of its complications in the diabetic patients.