Continuous glucose monitoring captures glycemic variability in obesity after sleeve gastrectomy: A prospective cohort study

Abstract

Abstract 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.

Keywords

• continuous glucose monitoring
• diabetes
• glycemic variability
• obesity
• sleeve gastrectomy