Key result
Sleeve gastrectomy leaves glycemic variability persistently higher in T2D versus non-diabetics despite ~3% HbA1c reductions.
Why the study?
HbA1c is insensitive for assessing real-time dysglycemia in obesity, prompting evaluation of whether 1-h plasma glucose during OGTT and CGM-measured glucose variability better reflect dysglycemia after sleeve gastrectomy.
Do continuous glucose monitoring and 1-h plasma glucose better capture persistent dysglycemia than HbA1c after sleeve gastrectomy in patients with type 2 diabetes?
Cohort (n=21)
Do continuous glucose monitoring and 1-h plasma glucose better capture persistent dysglycemia than HbA1c after sleeve gastrectomy in patients with type 2 diabetes?
Continuous glucose monitoring reveals persistent beta-cell dysfunction and glycemic variability in patients with type 2 diabetes after sleeve gastrectomy, despite significant improvements in HbA1c and weight.
Answers are grounded in this paper and cite their sources.
HbA1c reduction may mask persistent dysglycemia after sleeve gastrectomy; hypothesis-generating for CGM and 1-h glucose monitoring in type 2 diabetes.
Objective HbA1c is an insensitive marker for assessing real‐time dysglycemia in obesity. This study investigated whether 1‐h plasma glucose level (1‐h PG) ≥155 mg/dL (8.6 mmol/L) during an oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) measurement of glucose variability (GV) better reflected dysglycemia than HbA1c after weight loss from metabolic and bariatric surgery. Methods This was a prospective cohort study of 10 participants with type 2 diabetes compared with 11 participants with non‐diabetes undergoing sleeve gastrectomy (SG). At each research visit; before SG, and 6 weeks and 6 months post‐SG, body weight, fasting lipid levels, and PG and insulin concentrations during an OGTT were analyzed. Mean amplitude of glycemic excursions (MAGE), a CGM‐derived GV index, was analyzed. Results The 1‐h PG correlated with insulin resistance markers, triglyceride/HDL ratio and triglyceride glucose index in both groups before surgery. At 6 months, SG caused 22% weight loss in both groups. Despite a reduction in HbA1c by 3.0 ± 1.3% in the diabetes group ( p < 0.01), 1‐h PG, and MAGE remained elevated, and the oral disposition index, which represents pancreatic β ‐cell function, remained reduced in the diabetes group when compared to the non‐diabetes group. Conclusions Elevation of GV markers and reduced disposition index following SG‐induced weight loss in the diabetes group underscores persistent β ‐cell dysfunction and the potential residual risk of diabetes complications.
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Dorcely et al. (2024) conducted a cohort in Obesity with or without type 2 diabetes (n=21). Type 2 diabetes vs. Non-diabetes was evaluated on 1-h plasma glucose level and mean amplitude of glycemic excursions (MAGE). Despite a 3.0% reduction in HbA1c (p<0.01), patients with type 2 diabetes undergoing sleeve gastrectomy had persistently elevated 1-h plasma glucose and glycemic variability compared to non-diabetics.
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