Impact of Vertical Sleeve Gastrectomy in Youth-Onset Type 2 Diabetes: Changes in Glycemia, Insulin Sensitivity, and Secretion.

Abstract

This study evaluated impacts of vertical sleeve gastrectomy (VSG) on glycemic and cardiometabolic outcomes in youth-onset type 2 diabetes (YO-T2D). Pre- and postoperative (3 and 12 months) anthropometrics, mixed-meal tolerance test (MMTT) and body composition assessments, and hyperglycemic clamps (preoperative and 12 months postoperatively) were performed. Weight (-24.6 ± 5.2 kg at 3 months; -31.0 ± 5.2 kg at 12 months) and BMI (-8.5 ± 2.0 kg/m²; -10.8 kg/m²) fell by 18% and 23%, respectively (all p < 0.01). Body fat decreased 6.4% (p = 0.01) at 12 months, and fat mass by 16.8 ± 4.7 kg (p = 0.01). MMTT-stimulated GLP-1, PYY, insulin, and C-peptide secretion increased and insulin clearance, glucose, HbA1c (6.6% ± 0.2% to 5.7% ± 0.2%, p = 0.003), free fatty acids (FFA), LDL, triglycerides, adipose-focused Adipo-IR, liver transaminases and hepatic-predominant insulin sensitivity (Si) (HOMA-IR) decreased at 3 months post VSG. With maximal 12-month weight loss, MMTT-stimulated insulin, C-peptide, and GLP-1 responses attenuated, insulin clearance increased, muscle-predominant Si (hyperglycemic clamp M/I, Matsuda index, static/dynamic oral minimal modeling), β-cell function, resting heart rate, systolic blood pressure, and HDL improved, and all 3-month improvements persisted, with 86% of participants off diabetes medications. VSG in YO-T2D produces rapid and sustained improvements in weight, body composition, cardiometabolic health, Si, FFA, β-cell function, and glycemia, with most no longer needing diabetes medications. ClinicalTrials.gov identifier: NCT03620773.