Blood lipid profile in patients with obesity and type 2 diabetes mellitus and without type 2 diabetes mellitus before and after bariatric surgery

Background. Lipid metabolism disorders are observed in 60–70% of patients with obesity. Type 2 diabetes mellitus (DM2) is an independent risk factor for cardiovascular disease and is associated with increased cardiovascular risk. The presence of DM2 and hyperlipidemia determines the target group of patients for taking statins. However, at present, the prescription and administration of lipid-lowering therapy (LLT) remain unsatisfactory, and adherence to statin therapy also remains quite low. Bariatric surgery is currently becoming widespread due to its effectiveness in achieving DM2 remission. However, there are currently no recommendations regarding statin therapy in patients after bariatric interventions; clinical studies on this topic are few.

Objective. Evaluation of the blood lipid profile in patients with obesity and DM2 and without DM2 before and after bariatric surgery (BS).

Methods. An observational prospective study of 211 patients with grade I–III obesity was conducted. Patients were recruited from January 2018 to April 2023. Of the 211 patients enrolled in the study, 99 had confirmed type 2 diabetes, including 63 women and 36 men. All patients underwent gastrectomy (longitudinal gastrectomy – LG - or gastric bypass – GB – using the standard technique). All patients had their lipid profile assessed before gastrectomy and in the plateau phase. Cardiovascular risk was assessed to determine the patient’s need for LLT.

Results. In the study group of patients (n = 211), LLT was indicated in 163 (77.3%) patients, but only 36 (22%) of these patients received statins. Among diabetic patients (n = 99), LLT was received by 23 (23.2%) patients. The total cholesterol (TC) level in patients not receiving statin therapy was 5.0 ± 0.9 mmol/L, low-density lipoprotein (LDL) – 2.8 ± 0.8 mmol/L. In patients receiving LLT, the TC and LDL levels were slightly lower: TC – 4.6 ± 1.0; LDL – 2.4 ± 0.8 mmol/L (P> 0.05). Among obese patients with DM2, 42 (42.4%) patients underwent LG, 57 (57.6%) patients underwent GB. Among obese patients without DM2, 98 (87.5%) patients underwent LG, 14 (12.5%) patients underwent GB. In the group of patients without DM2 who underwent LG and GB, the TC level significantly decreased after BS (P < 0.05), and the LDL levels also slightly decreased. In the group of patients with DM2, a significant decrease in the TC and LDL levels was noted in the LG and GB groups (P < 0.05), both operations were comparable in terms of the decrease in the TC and LDL levels (P> 0.05). The achievement of target LDL values after BS was also assessed: in the group of patients with obesity and DM2, target LDL values were achieved by 65 patients (85.5%), in the group of patients with obesity without DM2 – 88 (88.9%). No significant differences were obtained between LG and GB in achieving target LDL values.

Conclusion. Metabolic surgery allows achieving a significant reduction in TC levels in obese patients with and without DM2, as well as LDL levels in obese diabetic patients.