Background: In adults, bariatric surgery has gradually emerged as a metabolic surgery, able to rapidly improve metabolic disturbances linked to severe obesity. Even if type 2 diabetes is rare in european obese adolescents, alterations in insulin sensitivity are present in almost all.
Objective and hypotheses: To evaluate the modification of insulin resistance (IR) and insulin sensitivity (IS) in severe obese adolescents who underwent bariatric surgery, comparing two methods: laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric banding (LGB).
Method: Forty patients followed for 12 months were studied. 20 underwent LSG (mean age 17.14±1.46 years, BMI 44.73±9.37; Z-score 4.7±0.95) and 20 underwent LGB (mean age 15.55±1.9 years; BMI 37.86±4.12; Z-score +4.48±0.68). IR was estimated by homeostasis model of assessment (HOMA-IR). The IS was evaluated by quantitative insulin sensitivity check index (QUICKI).
Results: Among patients who underwent LSG, improvement in IR was significant after 6 months (baseline HOMA-IR 4.7±0.95 vs 3.35±2.0 at T6, P=0.036) and 12 months (2.089±2.11). Normalisation of IS was observed in all patients after 6 months (baseline QUICKI 0.29±0.01; 0.34±0.03 at T6, P=0.020). The change in IS was not correlated with weight loss. In LGB patients, improvement of IS was slower, showing a trend without reaching significance (baseline HOMA-IR 4.87±2.62 vs 4.26±2.54 at T6, 3.95±3.20 at T12, baseline QUICKI 0.29±0.01, 0.31±0.02 at T6 and 0.32±0.03 at T12) and it was correlated to weight loss (P<0.001).
Conclusion: Our observation confirms the metabolic benefits of LSG even in a cohort of very young patients. Unlike LGB, the improvement of insulin sensitivity is sharp and not correlated to weight loss.
01 Oct 2015 - 03 Oct 2015