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

<b>Background:</b> Metabolic and bariatric surgery (MBS) results in significant changes in weight and body composition, along with glucose homeostasis improvement and type 2 diabetes resolution. In youth, sleeve gastrectomy (SG) is the most frequently performed MBS. Long-term studies assessing the duration over which glucose homeostasis parameters improve after SG are sparse. <b>Objective:</b> To examine the duration over which SG impacts glucose homeostasis in youth. <b>Methods:</b> This 24-month prospective study enrolled 65 youth (49 females) with moderate-severe obesity (mean age 18.0 ± 0.3 years). A total of 28 underwent SG, while 37 non-surgical (NS) participants received routine lifestyle counseling. At baseline, 12- and 24-month follow-up visits, HbA1c, and fasting and post-prandial insulin and glucose levels at 15, 30, 60, 90, and 120 min following a mixed meal tolerance test were obtained, and body composition was assessed. <b>Results:</b> At baseline, SG vs. NS had higher weight, body mass index (BMI) and percent fat mass (<i>p</i> ≤ 0.019), but did not differ for glucose homeostasis parameters. Over 24 months, reductions in weight-related parameters were noted in SG vs. NS (<i>p</i> ≤ 0.0001). Over 12 and 24 months, improvements occurred in HbA1c, fasting insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and the Matsuda index in SG vs. NS (<i>p</i> ≤ 0.002). However, the between-group difference for changes in glucose homeostasis parameters between 12 and 24 months was not significant. <b>Conclusions:</b> Improvements in glucose homeostasis occur mostly in the first year following SG, with subsequent stabilization of these measures.