Sex-Specific Glucose Homeostasis and Anthropometric Responses to Sleeve Gastrectomy in Obese Patients

Abstract

Bariatric surgery rapidly and effectively treats obesity and its comorbidities like dysregulated glucose homeostasis. Despite the sex-balanced incidence of obesity in most human populations, women have sought this intervention more frequently than men. However, as the number of bariatric surgeries rapidly rises, it is increasingly urgent to understand how sex-specific differences may emerge in metabolic and anthropometric parameters. Hundred fifty-four obese patients (47% men and 53% women) from the Bialystok Bariatric Surgery Study underwent sleeve gastrectomy and were measured for 25 parameters at baseline (immediately prior to surgery) and at four follow-up visits over one year. We used generalized linear mixed models to detect sex-specific differences in the time series of responses parameters. Unlike most previous studies with older cross-sections of men than women, our cohort was age-matched, and men were less healthy at baseline. Of parameters that showed a significant cohort-wide (across-sex) response, 14 (56%) also showed sex-specific responses with men improving more than women. In particular, men remitted in diabetes symptoms more strongly, rapidly, and durably than women. Taken together, our results indicate that men may benefit more from sleeve gastrectomy and that this difference in improvement may be related to more progressed morbidity prior to surgery independent of age.

Keywords: bariatric surgery; diabetes; gender; glucose homeostasis; sex; sleeve gastrectomy.

Figure 1

Qualification procedure and criteria for this study.

Figure 2

Model-adjusted means of responses scaled within individual patients from baseline to final follow-up visit (12 months post-surgery) adjusting for age and smoking status. Error bars are for standard errors. Asterisks indicate significant differences between sexes (p < 0.05). Ordered from the largest to the smallest difference between male and female mean response estimates. DXA—dual energy X-ray absorptiometry, HDL cholesterol—high-density lipoprotein cholesterol, LDL cholesterol—low-density lipoprotein cholesterol, OGTT—oral glucose tolerance test, BMI—body mass index, HOMA—homeostasis model assessment, AUC—area under the curve.

Figure 3

Two most sex-divergent long-term responses (i.e., with the largest difference in 12-month scaled responses between men and women), mean insulin (a) and glucose concentrations (b) during OGTT, from baseline to final follow-up exam. Points are model-adjusted means (see Methods). Dashed lines represent quadratic fits whose divergence is modeled by the generalized linear mixed models to test for significant time-by-sex interactions. Error bars are for standard errors.

Figure 4

Cross-sectional representation of the sex-divergent long-term responses (i.e., with the largest difference in 12-month scaled responses between men and women) divided by dysglycemia diagnosis from baseline to final follow-up exam. IFG is for impaired fasting glucose, IGT for impaired glucose tolerance, and T2D for type 2 diabetes. Points are model-adjusted means (see Methods). Dashed lines represent quadratic fits. Error bars are for standard errors.

Figure 5

T2D remission percentage (number remitted/number with type 2 diabetes at baseline) in men and women from baseline to final follow-up exam. Dashed lines represent quadratic fits. T2D–type 2 diabetes.