A 24-Month Prospective Study of the Effects of Sleeve Gastrectomy on Glucose Homeostasis in Youth.

At baseline, surgical participants had higher weight, BMI, and percent fat mass compared to non-surgical participants, but did not differ in glucose homeostasis parameters.

• 65 youth enrolled (49 females), mean age 18.0 ± 0.3 years
• 28 underwent sleeve gastrectomy (SG) and 37 non-surgical (NS) participants received routine lifestyle counseling
• Between-group differences in weight, BMI, and percent fat mass were significant at baseline (p ≤ 0.019)
• No significant baseline differences were found for glucose homeostasis parameters between SG and NS groups

Sleeve gastrectomy resulted in significant reductions in weight-related parameters compared to non-surgical controls over 24 months.

• Reductions in weight-related parameters were noted in SG vs. NS over 24 months (p ≤ 0.0001)
• Study design included body composition assessment at baseline, 12-month, and 24-month follow-up visits
• The non-surgical group received only routine lifestyle counseling as the comparator intervention

Significant improvements in glucose homeostasis parameters occurred in the SG group compared to NS over both 12 and 24 months.

• Improvements were observed in HbA1c, fasting insulin, HOMA-IR, and the Matsuda index in SG vs. NS (p ≤ 0.002)
• Glucose and insulin levels were measured at fasting and at 15, 30, 60, 90, and 120 minutes following a mixed meal tolerance test
• Improvements were statistically significant at both 12-month and 24-month timepoints compared to NS

The between-group difference for changes in glucose homeostasis parameters between 12 and 24 months was not significant, indicating stabilization after the first year.

• No significant between-group difference was found for changes in glucose homeostasis parameters from 12 to 24 months
• This suggests that the majority of metabolic improvement attributable to SG occurred within the first 12 months post-surgery
• Parameters assessed included HbA1c, fasting insulin, HOMA-IR, and Matsuda index

Sleeve gastrectomy is the most frequently performed metabolic and bariatric surgery in youth and is associated with glucose homeostasis improvement and type 2 diabetes resolution.

• Long-term studies assessing the duration over which glucose homeostasis parameters improve after SG in youth are described as sparse
• Metabolic and bariatric surgery results in significant changes in weight and body composition along with metabolic improvements
• This study was designed as a 24-month prospective study to address this gap in knowledge