Comparison of Sleeve Gastrectomy and Conservatory Treatment Effect on Biochemical and Hormonal Profile of Obese Type 2 Diabetes Subjects: CREDOR Randomized Controlled Study Results

Abstract

Metabolic surgery is the most efficacious method for the treatment of morbid obesity and was recently included among the antidiabetes treatments recommended in obese type 2 diabetes (T2D) patients. The aim of this study was to compare in a randomized controlled trial the effect of sleeve gastrectomy (SG) to that of intensive lifestyle intervention plus pharmacologic treatment on some markers of insulin resistance and beta cell function as well as some appetite controlling hormones in a group of male obese T2D subjects. The study groups comprised 20 subjects for SG and 21 control subjects. Fasting blood glucose, insulin, proinsulin, adiponectin, leptin, ghrelin, HOMA-IR, HOMA-%B, proinsulin-to-insulin ratio and proinsulin-to-adiponectin ratio were evaluated at baseline and after one year follow-up. Overall, patients in the SG group lost 78.98% of excess weight loss (%EWL) in comparison with 9.45% in the control group. This was accompanied by a significant improvement of insulin resistance markers, including increase of adiponectin and decrease of HOMA-IR, while no changes were recorded in the control group. Weight loss was also associated with a significant improvement of proinsulin-to-insulin and proinsulin-to-adiponectin ratio, both surrogate markers of beta cell dysfunction. These also improved in the control group, but were only marginally significant. Our findings suggest that improved insulin resistance and decreased beta cell dysfunction after sleeve gastrectomy might explain diabetes remission associated with metabolic surgery.

Oxidative Stress Profile and Type 2 Diabetes Remission at 6 Months After Sleeve Gastrectomy Versus Conservatory Treatment

“…No participant had any diagnosed systemic immune disorders and was known to be taking any form of vitamin supplementation neither at the time of recruitment nor after inclusion in this study. Detailed information regarding the procedures of this study was previously reported [16]. Briefly, 17 patients from the DTG and 19 from the LSG were evaluated after 6 months of follow up.…”

“…All subjects consulted a nutritionist before and during the study for dietary advice and instructions on preparation of their diets to assure good adherence to the study. Detailed presentation of the diet intervention was previously described [16]. In brief, individualized calorie count was based on the estimated Resting Metabolic Rate (RMR) from which a 500 kcal daily restriction was subtracted.…”

Evolution of Inflammatory and Oxidative Stress Markers in Romanian Obese Male Patients with Type 2 Diabetes Mellitus after Laparoscopic Sleeve Gastrectomy: One Year Follow-Up

“…Starting from the measured value for resting metabolic rate (RMR) and taking into account the "nutritional pattern" or identified dietary habits, a personalized diet was established for each patient from the conservative treatment group [46]. Specifically, the daily caloric requirement was calculated based on the formula [RMR * 1.3 (sedentary lifestyle) + (10% * RMR) (for the thermal effect of food) −500], thus inducing a 500 kcal daily restriction.…”

Evaluation of type 2 diabetes mellitus remission and oxidative stress profile after Laparoscopic Sleeve Gastrectomy (LSG) in Romanian obese male patients

“…Starting from the measured value for resting metabolic rate (RMR) and taking into account the "nutritional pattern" or identified dietary habits, a personalized diet was established for each patient from the conservative treatment group [13]. Specifically, the daily caloric requirement was calculated based on the formula [RMR*1.3 (sedentary lifestyle) + (10% * RMR) (for the thermal effect of food) -500], thus inducing a 500-kcal daily restriction.…”