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Baseline diabetes

T2DM has no impact on mental health post-RYGB

Baseline diabetes should be considered either a positive or a negative predictor of long-term mental health and HRQOL after RYGB surgery

A study investigating the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life (HRQOL) after Roux-en-Y gastric bypass (RYGB), has found no evidence that baseline diabetes should be considered either a positive or a negative predictor of long-term mental health and HRQOL after RYGB surgery.

“This study found significant improvements in BMI, mental health, HRQOL, weight-related body image, and physical fitness among the GASMITO patients undergoing RYGB,” concluded the authors from the University of Copenhagen, Copenhagen, Denmark. “Psychological differences in patients with and without baseline diabetes depended on time of assessment. The diabetic group had better mental health and HRQOL on all psychological measures before surgery. However, these differences resolved around the time of surgery and no significant differences between the two groups were observed postoperatively.”

The study, ‘The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass’, published in the Journal of Obesity, is part of the larger GASMITO study that is prospectively investigating psychological and physiological factors in severely obese RYGB patients with and without type 2 diabetes from the time before weight loss is started until weight stability is achieved 1.5 years after RYGB.

This study included 40 GASMITO participants who completed the psychological and physiological tests at baseline (A), 32 participants at two months after diet-induced weight-loss (B), 31 participants at four months after RYGB (C), and finally 23 participants at 18 months after RYGB (D).

Assessments

To assess mental symptoms, the researchers used a short version of the Danish ‘Symptoms Checklist’ (SCL-90) – a 90-item checklist assesses the severity of a wide range of mental symptoms and is scored on a scale ranging from 0 to 4 with 4 reflecting the highest level of symptom load. To assess quality of life and general health status of the patients, they used the ‘Short Form Health Survey 36’ (SF-36), which consists of 36 items evaluating eight aspects of HRQOL including physical function, physical role, physical pain, general health, vitality, social function, mental role, and mental wellbeing.

Information about the patients’ background, lifestyle, and medical status was obtained using a short version of the questionnaire that was developed as part of the Copenhagen Aging and Midlife Biobank (CAMB). This questionnaire comprises 76 questions providing information on social background, social situation, lifestyle, and physical health status.

The Body Image Questionnaire (BIQ) was used to assess the patients’ body image and comprises 50 items scored on a scale from 1 to 5, with 5 indicating a more positive body image.

Outcomes

In total, 40 bariatric patients were included in the GASMITO study, 30% (n=12) men and 70% (n=28) women. The participants’ mean age at baseline was 39.5 (±8.9) years, their mean BMI was 42.5 (±4.5) kg/m2, and their mean VO2max was 21.2 (±4.7) mL/kg/min, reflecting a very poor to poor level of physical fitness. Some Finally, 35% (n=14) of the participants had type 2 diabetes at baseline and 65% (n=26) were classified as nondiabetic. Patients with and without diabetes had similar age, weight, BMI, and VO2max prior to surgery. However, body fat % was lower in the diabetic than in the nondiabetic patients (45.1% (±5.9) versus 49.6% (±5.5), p=0.024).

The outcomes showed that weight and BMI improved significantly in the bariatric patients and were highly significant from baseline to follow-up (B) immediately before surgery and continued to be highly significant throughout the surgical course. At follow-up (D), 18 months after RYGB, the mean percent excess weight loss (% EWL) from baseline reached 65% (±12) and percent weight loss (% WL) was 30% (±6), indicating a successful surgical weight loss outcomes. Patients with and without type 2 diabetes at baseline did not differ significantly with regard to % EWL. At 18-month follow-up, the two groups reached a EWL of 63.0% and 66.0%, respectively (Table 1).

Table 1: Improvement of weight, BMI, physical fitness (VO2max), mental health (SCL-90), HRQOL (SF-36), and body image (BIQ) from baseline to time point (B), from time point (B) to time point (C), and from time point (C) to time point (D). SE: standard error; GSI: General Severity Index (*p<0.05;**p<0.001)

Furthermore, of the 14 patients with baseline type 2 diabetes, 50% () experienced total remission after surgery and only 21% () clearly met the criteria for diabetes (HbA1c > 48) postoperatively. Also, VO2max increased significantly after surgery possibly explained by the decreased body mass of the patients.

At 18-month follow-up, the bariatric patients reported a significant reduction of mental symptoms and a significant increase in HRQOL and weight-related body image compared with baseline values, indicated by lower scores on the somatization, depression, anxiety, and GSI subscale of the SCL-90 and higher scores on the eight SF-36 subscales and the weight-related BIQ subscale ( for all subscales).

As Table 1 shows, the improvements were evident in most of the SCL-90 and SF-36 subscales from the time immediately before surgery (follow-up (B)) to four months after surgery (follow-up (C)) with the most pronounced improvements observed on the physical HRQOL subscales. Of the SCL-90 and SF-36 subscales, only somatization and social function did not improve during the first four postoperative months. Furthermore, the somatisation, depression, GSI, physical function, vitality, and social function subscales improved postoperatively until 18 months after surgery. Finally, the weight-related body image score increased significantly throughout the surgical course and was, together with physical function, the only subscale demonstrating significant changes at each follow-up.

“Future studies should prospectively investigate the long-term (>five-year follow-up) effects of type 2 diabetes and physical activity on mental health and HRQOL in a larger bariatric sample using objective methods to obtain information about weight, BMI, diabetes status, and physical activity,” the authors write. “Specifically, physical activity is of importance as this factor is clinically meaningful and can potentially be modified. Research should therefore seek to clarify the most optimal type and intensity of physical activity that result in successful outcome with regard to both weight loss and psychological wellbeing after bariatric surgery.”

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