Glycemic Normalization Immediately Following Vertical Sleeve Gastrectomy in Adolescents With Type 2 Diabetes From the...

Youth-onset type 2 diabetes and obesity are rising public health burdens. While newer type 2 diabetes medications lower HbA1c, their impact on paediatric weight loss is inconsistent. In contrast, bariatric surgery improves glycemia and weight in youth and adults, though glycemia post-vertical sleeve gastrectomy (VSG), now the predominant bariatric surgery in youth, remains unstudied in youth-onset type 2 diabetes. We aimed to assess immediate post-VSG glycemic patterns using continuous glucose monitoring (CGM) in adolescents with type 2 diabetes.

In the Surgical or Medical Treatment for Paediatric Type 2 Diabetes (ST₂OMP) study, 73 adolescents with type 2 diabetes underwent 14 days of CGM monitoring: 33 participants beginning in the 1-2 days post-VSG (mean age 17.6 years, 67% female, HbA1c 7.2%, BMI 50.0 kg/m²) and 40 participants receiving advanced medical therapy (AMT) (mean age 16.9 years, 53% female, HbA1c 7.8%, BMI 42.2 kg/m²). CGM analyses included glucose management indicator (GMI), time in range, coefficient of variability, standard deviation, mean amplitude glycemic excursion, percent > 140, 180, and 200, percent < 70 and 60 mg/dL, 7 a.m., and midnight-6 a.m.

Mean glucose was 84.3 ± 23.4 in the post-VSG group versus 149.8 ± 78.8 mg/dL in the AMT group (p < 0.001). Mean CGM GMI was normal (5.3%, 34 mmol/mol) post-VSG versus in the diabetes range (6.9%, 52 nmol/mol) with AMT (p < 0.001). VSG participants spent more time < 70 mg/dL, 55 mg/dL, and 45 mg/dL (all p < 0.01). After BMI adjustment, preoperative HbA1c predicted postoperative glucose metrics.

Adolescents with type 2 diabetes experience early glycemic normalization post-VSG, even before major weight loss.