Changes in Insulin Resistance with Different Weight Loss Methods in Patients with Type Two Diabetes Mellitus and Hypertension: A Comparative Clinical Trial
Oshakbayev K. Durmanova A. Kuttymuratov G. Bikhanov N. Nabiyev A. Suleimenov T. Idrissov A. Shakhmarova T. Mirmanova Z. Rakhimova S. Kozhamkulov U. Akilzhanova A.
January 2026Multidisciplinary Digital Publishing Institute (MDPI)
Journal of Clinical Medicine
2026#15Issue 2
Background: The comparative effects of pharmacological treatment, bariatric surgery, and diet on insulin resistance (IR) remain unclear. Aim: To study the comparative effects of the methods on IR: pharmacologic, bariatric surgery, and very-low-calorie diet (VLCD) in patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods: Design: a 90-day prospective, multicenter, comparative clinical trial including 130 adult patients divided into three groups: Drug, Surgery, and VLCD. Endpoints: HOMA-IR; weight loss; and HbA1c, systolic/diastolic blood pressure (SBP/DBP). Results: At 90 days, weight loss in the Surgery (−19.8%) and VLCD groups (−17.4%) was significant (p < 0.0001), while in the Drug group, the loss was insignificant (−6.5%; p = 0.06). SBP/DBP in the Drug group decreased by −9.5% (p = 0.0002) and −4.1% (p = 0.09), respectively. SBP/DBP in the Surgery group decreased by −13.6% and −10.6%, respectively (p < 0.001), and in the VLCD group, by −23.3% and 21.3%, respectively (p < 0.0001). HOMA-IR in Drug, Surgery, and VLCD groups decreased by −42.2% (p = 0.004), −87.6% (p < 0.0001), and −88.7% (p < 0.0001), respectively. In the Drug group, HOMA-IR did not reach the normal level. Correlation-regression analysis revealed a direct correlation between weight loss and a decrease in HOMA-IR (r = 0.526; F = 33.2, p < 0.0001). HOMA-IR decreases by 65% if weight decreases by 10%; if weight decreases by 25%, then HOMA-IR decreases by 83%. Conclusions: HOMA-IR was associated with weight loss: the greater the weight loss, the lower the HOMA-IR. Weight loss leads to a reduction in the need for antidiabetic/antihypertensive drugs in patients with T2DM and hypertension.
bariatric surgery , hypertension , insulin resistance , semaglutide , type 2 diabetes mellitus , very-low-calorie diet , weight loss
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Clinical Academic Department for Internal Medicine, University Medical Center, Syganak Str. 46, Astana, 010000, Kazakhstan
Department of Endocrinology, University Medical Center, Syganak Str. 46, Astana, 010000, Kazakhstan
Department of Surgery, University Medical Center, Syganak Str. 46, Astana, 010000, Kazakhstan
Department of Family Medicine, Astana Medical University, Street Beibitshilik 49a, Astana, 010000, Kazakhstan
Laboratory of Genomic and Personalized Medicine, Center for Life Sciences, National Laboratory Astana, Nazarbayev University, 53 Kabanbay Batyr Ave, Astana, 010000, Kazakhstan
Eurasian Society of Personalized Medicine, 10 R. Koshkarbayev Ave, Astana, 010000, Kazakhstan
Clinical Academic Department for Internal Medicine
Department of Endocrinology
Department of Surgery
Department of Family Medicine
Laboratory of Genomic and Personalized Medicine
Eurasian Society of Personalized Medicine
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