Age and Gender on the Efficacy of Metabolic Surgery in Patients with Obesity and Type 2 Diabetes
Bo Ma, Yangfan Dong, Tao Li, Jun Wang, Hua Ma, Shaohua ShangIntroduction:
This study aims to investigate the influence of age and gender on the efficacy of metabolic surgery in patients with obesity with type 2 diabetes mellitus (T2DM).
Materials and Methods:
This is a prospective cohort study. A total of 95 patients with obesity and T2DM who underwent metabolic surgery between June 2022 and October 2024 were enrolled. Patients were divided into four groups based on their age and gender as follows: young (<35 years) men, young women, middle-aged (35–55 years) men and middle-aged women. Body mass index (BMI) data, glycated haemoglobin (HbA1c) levels and gastrointestinal peptide hormone (e.g. glucagon- like peptide-1 (GLP-1), peptide YY (PYY) and ghrelin (GHRL)) levels, as well as Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale (HAM-D) scores, were collected preoperatively and at 1, 3 and 6 months postoperatively. Gastrointestinal peptide hormone levels were measured using enzyme-linked immunosorbent assay, and anxiety and depression statuses were assessed using online questionnaires. Data were analysed using repeated measures analysis of variance, paired t-tests, analysis of covariance and multiple linear regression, with adjustments for baseline BMI, diabetes duration and surgical type (laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass) where appropriate.
Results:
Both BMI and HbA1c levels decreased significantly in all groups postoperatively, with a greater reduction observed in the younger groups compared with the middle-aged groups at the 6- month timepoint (adjusted p < 0.01). The percentage of total weight loss was lower in women than in men (mean difference: 2.8%, 95% confidence interval: 1.1–4.5, p = 0.03). Among gastrointestinal peptide hormones, GLP-1, PYY and cholecystokinin (CCK) significantly increased, whereas GHRL, insulin (INS) and leptin significantly decreased postoperatively. The increase in GLP-1 was more pronounced in the younger groups than in the middle-aged groups (r = −0.312, p < 0.05). Hamilton Anxiety Rating Scale scores were negatively correlated with INS (r = −0.297, p < 0.05) and positively correlated with GHRL (r = 0.286, p < 0.05), whereas HAM-D scores were negatively correlated with CCK (r = −0.258, p < 0.05). Multivariate analysis revealed that younger age (β = −0.251, p = 0.004), female gender (β = 0.178, p = 0.041), and higher HAM-A scores (β = 0.327, p = 0.002) were independent factors influencing the significant changes observed in gastrointestinal hormone levels.
Discussion:
Individualised treatment plans based on patient age, gender and psychological status should be developed in clinical practice, and lifestyle and psychological interventions should be developed further to improve surgical outcomes and maintain the long-term efficacy of metabolic surgery.
Conclusion:
Metabolic surgery is effective in patients with obesity with T2DM, with younger patients experiencing greater metabolic improvement.