K. Shpanskaya1, H. Khoury1, H. Rivas1, J. Morton1 1Stanford University,Palo Alto, CA, USA
Introduction: Bariatric surgery is profoundly effective in improving and resolving type 2 diabetes mellitus (T2DM) in the severely obese. Our study aims to investigate the role of gender differences in T2DM remission and its related serum markers 12 months after bariatric surgery.
Methods: We performed a retrospective study of 817 severely obese T2DM patients that underwent laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. T2DM remission was defined as complete or partial with a glycated hemoglobin (HbA1c) of less than 6.0% or 6.5%, respectively, with no diabetes medication use for 12 months after surgery. HbA1c, fasting glucose, and insulin were measured preoperatively and 12 months postoperatively. Data were analyzed using student’s t-test and multivariate regression analysis, controlling for age, change in BMI, type of surgery, and number of preoperative comorbidities.
Results: 213 males and 604 females with a mean age of 50.42 (SD 9.76) and 48.55 (SD 10.57), respectively, and an average preoperative BMI of 46.26 (SD 8.35) and 46.83 (SD 7.85) were included in this study. Preoperatively, HbA1c levels from males (N=184; 7.81, SD 1.80) and females (N=530; 7.01, SD 1.40) significantly differed (P=0.000). Initial fasting glucose was significantly higher (P=0.010) in males (N = 136; 151.44, SD 59.74) than in females (N=349; 137.08, SD 53.05). Females (N = 226; -15.35, SD 9.25) showed significantly greater BMI reduction at 12 months post-surgery than males (N= 76; -12.7, SD 10.43) (P=0.037). Males and females showed significant one-year improvement in HbA1c (P = 0.000; males from 8.1% to 5.4%, females from 7.1% to 5.5%), fasting glucose (P = 0.000; males from 149.97 to 101.76 mmol/L, females from 136.17 to 96.32 mmol/L), and insulin (P =0.000; males from 29.5 to 5.38 UI/L, females from 34.07 to 7.63 UI/L). One year after surgery, males (N=41; -2.67, SD 1.87) had a greater decrease in HbA1c levels (P=0.001) than females (N=153; -1.60, SD 1.48) after controlling for age, 12 month weight loss, and preoperative comorbidities. Change in fasting glucose (P=0.511) and insulin (P=0.728) at 12 months after surgery did not significantly differ. Postoperatively, no significant difference in HbA1c, in fasting glucose, or in insulin levels was seen. Neither complete nor partial T2DM remission one year after surgery was significant between genders (P=0.372, P=0.514).
Conclusion: Our study is one of the first to explore gender differences in T2DM remission and diabetes serum markers at one year after bariatric surgery. Males show higher preoperative HbA1c levels and greater benefit of surgery for HbA1c levels at 12 months. Diabetes remission and reduction in fasting glucose and insulin levels at one year after surgery were not significantly different between males and females. Despite a worsened glycemic profile preoperatively, male bariatric surgery patients demonstrated significant improvement in diabetes markers similar to female bariatric surgery patients.