Effect of sleeve gastrectomy on patients with diabetes mellitus

doi:10.1016/j.soard.2008.11.006

Surgery for Obesity and Related Diseases

Volume 5, Issue 4, July–August 2009, Pages 429-434

Accepted as a podium presentation at the American Society for Metabolic and Bariatric Surgery 2008

https://doi.org/10.1016/j.soard.2008.11.006 Get rights and content

Abstract

Background

Limited data are available evaluating the effect of sleeve gastrectomy on the control of DM. Our objective was to evaluate the effectiveness of sleeve gastrectomy in improving glycemic control of obese patients with diabetes mellitus (DM) at a research clinic.

Methods

A retrospective review of a prospectively maintained database collected between January 2005 and January 2007 was conducted. A total of 30 patients with DM who had undergone laparoscopic sleeve gastrectomy were studied. At the 2- and 6-month follow-up visits, we analyzed the variation in glycosylated hemoglobin, fasting blood glucose, and body mass index.

Results

Of the 30 patients with ≥6 months postoperative follow-up, 22 (73%) had been taking medications for type 2 DM preoperatively. Resolution of DM was observed in 27% at 2 months and 63% at 6 months of follow-up. Glycosylated hemoglobin decreased from 6.36 ± .82 (n = 14) preoperatively to 6.02 ± .57 (n = 11) at 2 months and 5.92 ± .33, (n = 12) at 6 months after surgery. The body mass index decreased from 46.12 ± 10.86 (n = 30) preoperatively to 38.27 ± 6.59 (n = 30) at 2 months and 35.78 ± 5.11 (n = 29) at 6 months after surgery. Patients with a shorter duration of DM (<5 yr) and better weight loss after surgery achieved greater resolution rates.

Conclusion

The improvement and resolution of DM in obese patients has been observed as a result of weight loss after sleeve gastrectomy.

Section snippets

Methods

After institutional review board approval, we conducted a retrospective chart review of a prospectively collected database for all patients with DM, who had undergone laparoscopic sleeve gastrectomy (LSG) as a final approach for the treatment of morbid obesity. We included only those patients who had completed ≥6 months of follow-up postoperatively at the Bariatric and Metabolic Institute at Cleveland Clinic Florida from January 2005 to January 2007. A total of 30 patients with DM who had

Results

The mean operative time was 95 minutes (range 55–180), and all operations were performed laparoscopically. The mean hospital stay was 3.2 days (range 1–19). No patient in this series died. At the 2- and 6-month follow-up visits, we analyzed the variation in HbA1c, fasting blood glucose, and BMI. Of the 30 patients, 21 (70%) were women and 9 (30%) were men; 18 (60%) were white, 6 (20%) were Hispanic, 3 (10%) were black, and 3 (10%) were Asian. The mean age of the studied group was 42.3 years

Discussion

In agreement with previous reports on the evolution of DM after bariatric surgery, we have shown that the clinical features of preoperative DM are important determinants of the likelihood of biochemical remission. Schauer et al. [6], [7] found that after laparoscopic Roux-en-Y gastric bypass, the odds of type 2 DM remission were greater for those with a shorter duration and milder disease. Similar results were reported by Torquati et al. [25]. Our results lend additional support to these data

Conclusion

We agree that the mechanisms of the remission of type 2 DM are yet to be demonstrated; however, we also believe that it is important for the surgeon to be aware of the different theories that might help us achieve these results. We recognize the limitations of our study; for instance, some of our patients might have been diagnosed with early DM or glucose intolerance that was controlled by diet without medication, and the data on these patients were not available for analysis. Our study has

Disclosures

The authors claim no commercial associations that might be a conflict of interest in relation to this article.

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Cited by (67)

Remission with an Intervention: Is Metabolic Surgery the Ultimate Solution?
2023, Endocrinology and Metabolism Clinics of North America
Factors associated with complete and partial remission, improvement, or unchanged diabetes status of obese adults 1 year after sleeve gastrectomy
2020, Surgery for Obesity and Related Diseases
Citation Excerpt :
The literature on the association of a range of characteristics with T2D remission after SG is limited [6,7] and reveals several gaps. Most studies that examined the T2D remission after bariatric surgery but did not assess the features associated with such remissions [12]. In addition, research assessed such characteristics in gastric bypass surgery more than in SG [6,10,13,14], despite the widespread use of SG.
Laparoscopic sleeve gastrectomy (SG) achieves type 2 diabetes (T2D) remission to various extents, and reasons for such variations are unknown.
We assessed patients’ characteristics associated with T2D remission 1 year post SG.
University hospital.
Retrospective study of 230 T2D patients (18–64 yr) who underwent SG at our institution. We examined pre- and postoperative demographic, anthropometric, biochemical, and clinical characteristics associated with T2D complete remission, partial remission, improvement, or unchanged status. Independent predictors of T2D complete remission were assessed by binary logistic regression and then included in 7 predictive models. Logistic regression assessed the pre- and postoperative predictors of T2D complete remission and their predictive performance was measured with the area under the curve of the receiver operating characteristic curve.
A total of 230 patients were included in the study, females comprised 69%, and mean age was 45.66 ± 8.84 years. Mean preoperative weight and body mass index were 115.69 ± 20.76 kg and 43.53 ± 6.98 kg/m², respectively. Approximately two thirds (64.4%) of the sample had diabetes for >5 years. Insulin therapy users comprised 36.9% of the sample and 29.6% of patients were on ≥2 oral hypoglycemic agents (OHA). At 1 year, mean body mass index was 32.77 ± 6.09 kg/m², percent excess weight loss (%EWL) was 62.29 ± 23.60% and glycosylated hemoglobin (HbA1C) improved from 8.1% to 6.18%. Approximately 42.2% of the sample achieved T2D complete remission. Compared with those with no remission, patients with complete remission were significantly younger, had shorter duration of diabetes, were not on insulin therapy, took fewer OHA, had higher C-peptide, lower preoperative HbA1C, were less likely to have had hypertension or dyslipidemia, and more likely to have achieved higher %EWL. Seven proposed models for prediction of complete remission showed the most useful model comprised diabetes duration + pre-HbA1C + %EWL + insulin therapy + age + OHA (area under the curve = .81). Independent predictors of complete remission were preoperative HbA1C, %EWL, insulin therapy, age, and OHA (but not diabetes duration).
SG results in significant weight reduction and various extents of T2D remission. HbA1C, %EWL, insulin therapy, age, and OHA were independent predictors of complete remission. Assessing these factors before bariatric surgery is important to identify any modifiable characteristics that can be altered to increase the likelihood of remission.
Laparoscopic sleeve gastrectomy: Effect on long-term remission for morbidly obese patients with type 2 diabetes at 5-year follow up
2017, Surgery (United States)
In the short-term, laparoscopic sleeve gastrectomy has been shown to be effective for the treatment of the type 2 diabetes in patients with severe obesity. There are few data with greater follow-up. Our aim was to evaluate the results of laparoscopic sleeve gastrectomy on the control of type 2 diabetes in patients with severe obesity at 5 years at the University Hospital, France.
From a total of 355 patients with severe obesity operated between January 2006 and June 2010, 52 (15%) had a diagnosis of type 2 diabetes before undergoing laparoscopic sleeve gastrectomy.
There were 31 females (60%) and 21 males (40%), with a mean age of 51 ± 10 years (range 27–67) with a mean body mass index of 48 ± 10 kg/m² (range 35–82). The mean duration of type 2 diabetes was 10.8 ± 10.8 years before bariatric operation. The preoperative glycated hemoglobin was 8 ± 2% (range 5.9–12.8) in 45 patients; 17 patients (38%) had levels of glycated hemoglobin ≥9%. Three patients (6%) required insulin alone, 4 (8%) were taking oral antidiabetic medicine and insulin, and the remaining 45 patients (87%) were taking only oral antidiabetic medicines. The complete data regarding weight loss at 5-year follow-up were obtained for 46 patients, yielding an overall follow-up rate of 89%. The prolonged remission of type 2 diabetes achieved at 1 year that persisted at 5 years of follow-up was present in 9 patients (17%). No patient with complete remission of their type 2 diabetes required insulin preoperatively. Improvement of type 2 diabetes was observed in 30 patients (58%) at 1 year, which was maintained for 27 patients (52%) at 5-year follow-up.
Laparoscopic sleeve gastrectomy has demonstrated a moderate efficacy in the treatment morbidly obese patients with type 2 diabetes. Markedly increased preoperative glycated hemoglobin levels, older age, and preoperative need for insulin treatment may be the factors predicting failure of complete remission of type 2 diabetes after laparoscopic sleeve gastrectomy.
Paired editorial: Long-term results (8 years) after sleeve gastrectomy
2017, Surgery for Obesity and Related Diseases
Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to Roux-en-Y gastric bypass: Systemic review and meta-analysis
2015, Surgery for Obesity and Related Diseases
Citation Excerpt :
RYGB, which has both malabsorptive and restrictive mechanisms, promotes early remission and sustained long-term control of T2D [12,13]. Meanwhile, SG can also control T2D but is believed to have a hormonal mechanism in addition to its restrictive component [14,15]. To date, several studies have compared SG and RYGB for the treatment of severe obesity and metabolic syndrome.
Until recently, Roux-en-Y gastric bypass (RYGB) was the most frequently performed procedure in bariatric surgery. In the last decade, sleeve gastrectomy (SG) has emerged as a more popular, simpler, and less morbid form of bariatric surgery.
This study compares the efficacy of SG and RYGB for the treatment of type 2 diabetes mellitus (T2D).
Systemic review and meta-analysis.
MEDLINE, EMBASE, and the Cochrane Library were searched for entries up to December 2013. Search terms included “Sleeve gastrectomy,” “Gastric bypass,” and “Type 2 diabetes mellitus.” The chosen articles described both “Sleeve gastrectomy” and “Gastric bypass” and included over 1 year of follow-up data. Data analysis was performed with Review Manager 5.2 and SPSS version 20.
The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the SG group and 428 patients in the RYGB group. In nonrandomized clinical studies, SG displayed similar efficacy in remission of T2D compared with the standard RYGB. In the RCTs, SG had a lower effect than that of RYGB. T2D remission was not correlated with the percent of excess weight loss for either procedure.
Based on the current evidence, SG has a similar effect on T2D remission as RYGB.
Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: Predicting the success by ABCD score
2015, Surgery for Obesity and Related Diseases
Laparoscopic sleeve gastrectomy (LSG) is becoming a primary bariatric surgery for obesity and related diseases. This study presents the outcome of LSG with regard to the remission of type 2 diabetes mellitus (T2 DM) and the usefulness of a grading system to categorize and predict outcome of T2 DM remission.
A total of 157 patients with T2 DM (82 women and 75 men) with morbid obesity (mean body mass index 39.0±7.4 kg/m²) who underwent LSG from 2006 to 2013 were selected for the present study. The ABCD score is composed of the patient’s age, body mass index, C-peptide level, and duration of T2 DM (yr). The remission of T2 DM after LSG was evaluated using the ABCD score.
At 12 months after surgery, 85 of the patients had complete follow-up data. The weight loss was 26.5% and the mean HbA_1c decreased from 8.1% to 6.1%. A significant number of patients had improvement in their glycemic control, including 45 (52.9%) patients who had complete remission (HbA_1c<6.0%), another 18 (21.2%) who had partial remission (HbA_1c<6.5%), and 9 (10.6%) who improved (HbA_1c<7%). Patients who had T2 DM remission after surgery had a higher ABCD score than those who did not (7.3±1.7 versus 5.2±2.1, P<.05). Patients with a higher ABCD score were also at a higher rate of success in T2 DM remission (from 0% in score 0 to 100% in score 10).
LSG is an effective and well-tolerated procedure for achieving weight loss and T2 DM remission. The ABCD score, a simple multidimensional grading system, can predict the success of T2 DM treatment by LSG.

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Original articleEffect of sleeve gastrectomy on patients with diabetes mellitus

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

J Gastrointest Surg

Obesity as a medical problem

Nature

Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults

Diabetes Care

Effect of abdominal obesity on insulin resistance and the components of the metabolic syndrome: evidence supporting obesity as the central feature

Obes Surg

Surgery for severe obesity

N Engl J Med

Who would have thought it?An operation proves to be the most effective therapy for adult-onset diabetes mellitus

Ann Surg

Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity

Ann Surg

Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus

Ann Surg

Laparoscopic gastric bypass Roux-en-Y—500 patients: technique and results, with 3–60 month follow-up

Obes Surg

Diabetes and hypertension in severe obesity and effects of gastric bypass induced weight loss

Ann Surg

Achievement of near-normal body weight as the prerequisite to normalize sex hormone-binding globulin concentrations in massively obese men

Int J Obes

Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding

Diabetes Care

Laparoscopic adjustable gastric banding for the treatment of morbid (grade 3) obesity and its metabolic complications: a three year study

J Clin Endocrinol Metab

Original article
Effect of sleeve gastrectomy on patients with diabetes mellitus