Perda de excesso de peso e melhora da resistência à insulina em pacientes acompanhados por equipe multidisciplinar de cirurgia bariátrica: comparação entre público e privado

Abstract

Introduction: Insulin resistance is the main link between obesity and type 2 diabetes mellitus. Bariatric surgery has been shown to be an effective therapy for both weight loss and resolution of comorbidities. Objective: To compare the evolution of insulin resistance and therapeutic success in patients undergoing bariatric surgery in public and private healthcare services. Methodology: Retrospective cohort study, with data collection from medical records of patients followed by bariatric surgery services, during the period from 2016 to 2020. Insulin resistance was evaluated using the Triglyceride Glucose Index and HOMA-IR scores. Results: A total of 85 patients participated in the study, with 62% being female. The mean preoperative BMI was 43.64±8.59 kg/m2. In the overall sample, bariatric surgery reduced all analyzed variables: weight, BMI, excess weight, fasting glucose, glycated hemoglobin, insulin levels, triglyceride glucose index, and HOMA-IR (p<0.05). The success rate, defined as excess weight loss >50%, was 64% among patients in the public healthcare system and 87.5% among patients in the private system (p<0.05). There was no correlation between the percentage of excess weight loss and improvement in insulin resistance (p<0.05). Conclusion: Bariatric surgery proved to be effective in reducing excess weight and improving the analyzed parameters. The success rate was higher among patients in the private healthcare system. The reduction in insulin resistance measured by the Triglyceride Glucose Index was not correlated with excess weight loss, demonstrating that metabolic parameters improve independently of weight reduction.