Bariatric Surgery for the Treatment of Morbid Obesity: Early effects on Glycemic Control, Inflammatory and Carotid Arteries Wall Thickness Status

Background: Cardiovascular diseases and type 2 diabetes mellitus (T2DM) are the leading reasons for premature morbidity and mortality in patients with extreme obesity. Currently, there is limited success in changing this course by nutritional and pharmacological intervention. Therefore, we have attempted to assess the early effects of bariatric surgery on metabolic, glycemic, inflammatory and on carotid arteries wall thickness status in obese patients, all of them mediate accelerated atherosclerotic in these patients. Methods: Twenty two patients, 11 with and 11 without T2DM were followed for three months after surgery. Fasting blood glucose, HbA1C and lipids were performed and carotid intima-media thickness (IMT) was measured. Results: Bariatric surgery resulted in a significant weight loss from 126±24 to 102±21 kg (mean±SD, p<0.0001) with a 46±13% reduction in excess weight (EWL). Some markers of inflammation dropped significantly: White blood cells (WBC) from 9.3×103 to 7.6×103/μL and C-Reactive Protein (CRP) from 13.5 to 8.2 mg/L (p<0.0001). Fasting glucose decreased from 126 to 102 mg/dL (p=0.006) while HbA1C decreased from 7.2% to 5.7% (p<0.0001). In patients with diabetes, fasting glucose dropped from 162 to 122 mg/dL(p=0.04) whereas HbA1C dropped from 8.2 to 5.9% (p=0.005), thus moving from a diabetic to a non-diabetic range. IMT did not show any improvement throughout the 3 month study. Conclusion: Bariatric surgery had dramatic effects on glycemic control and inflammatory status in patients with T2DM as early as three months after surgery. If sustained, such response after surgery may confer protection against future cardiovascular morbidity and mortality through mechanisms presented in our study.