Bariatric surgery is superior to medical treatment for type 2 diabetes mellitus (T2DM) control in obese patients. Reports in the literature have been mainly based on Roux-en-Y gastric bypass (RYGB) or adjustable gastric band. The aim of this study was to analyze mid- and long-term metabolic results after laparoscopic sleeve gastrectomy (LSG).
Methods:
Obese patients with T2DM undergoing LSG were included in this study. Selection criteria for T2DM remission were: post-operatory fasting glucose (FG) level <100 mg/dL, and hemoglobin A1c (HbA1c) <6% without medication.
Results:
Between January 2009 and July 2016, 166 T2DM obese patients underwent LSG and completed ≥1 year follow-up. There were 101 women (60.8%; mean age 49.07 ± 12.8 years). Initial body mass index (BMI) was 46.44 ± 7.68 kg/m2. Mean time since T2DM diagnosis was 5.95 years (1–28). Preoperative HbA1c was 7.53% ± 0.97%. Before LSG, 75.3% (n = 125) were receiving oral hypoglycemic agents, and 13.25% (n = 22) insulin. Mean follow-up was 65 ± 10 months. Complete T2DM remission was achieved in 78.3%, 76.2%, and 71.4% at 1, 3, and ≥5 years respectively; in the long term, 7.2% attained partial remission, 10% improved, and 11.4% experienced recurrence of the disease. Remission rate was significantly lower in patients under insulin therapy preoperatively, and in patients with T2DM diagnosed ≥5 years before consultation (P = .0004 and .0001, respectively).
Conclusions:
At mid- and long-term follow-up, T2DM control was satisfactory after LSG. Preoperative insulin therapy and T2DM duration ≥5 years were predictors of less favorable outcomes.
Get full access to this article
View all access options for this article.
References
1.
International Diabetes Federation. IDF Diabetes Atlas, 8th Ed. KarurangaS, da Rocha FernandesJ, HuangY, MalandaB (eds). Brussels, Belgium: IDF, 2017.
2.
BeguéC.Third national survey of risk factors for noncommunicable diseases. Buenos Aires, Argentina: Health National Ministery, 2015.
3.
YangW, DallT, HalderP, GalloP, KowalS, HoganP. Economic costs of diabetes in the U.S. in 2012. Diabetes Care, 2013; 36:1033–1045.
4.
TorgesonJS, HauptmanJ, BoldrinMN, SjöströmL. XENical in the prevention of diabetes in obese subjects (XENDOS) study: A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care, 2004; 27:155–161.
5.
StevensVJ, ObarzanekE, CookNR, LeeIM, AppelLJ, Smith WestD, et al.Long-term weight loss and changes in blood pressure: Results of the trials of hypertension prevention phase II. Ann Intern Med, 2001; 134:1–11.
6.
The Look AHEAD Research Group. Cardiovascular Effects of Intensive Lifestylke Intervention In Type 2 Diabetes. N Engl J Med, 2013; 369:145–154.
7.
CasagrandeS, FradkinJ, SaydahS, RustK, CowieC. The prevalence of Meeting A1C, Blood Pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care, 2013; 36:2271–2279.
8.
PoriesW, SwansonM, MacDonaldK, LongS, MorrisP, BrownB, et al.Who would have thought it?. An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg, 1995; 3:339–352.
9.
PeterlyR, SteinertR, WoelenerhanssenB, PetersT, Christoffel-CourtinC, GassM, et al.Metabolic and hormonal changes after laparoscopic roux-en- Y gastric bypass and sleeve gastrectomy: A randomized, prospective trial. Obes Surg, 2012; 22:740–748.
IkramuddinS, KornerJ, LeeWJ, ConnettJE, InabnetWB, BillingtonCJ, et al.Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: The Diabetes Surgery Study randomized clinical trial. JAMA, 2013; 309:2240–2249.
12.
AdamsTD, DavidsonLE, LitwinSE, KolotkinRL, LaMonteMJ, PendletonRC, et al.Health benefits of gastric bypass surgery after 6 years. JAMA, 2012; 308:1122–1131.
13.
HimpensJ, VerbruggheA, CadièreGB, EveraertsW, GreveJW. Long term results of laparoscopic Roux-en-Y Gastric bypass: Evaluation after 9 years. Obes Surg, 2012; 22:1586–1593.
14.
SchauerPR, BurgueraB, IkramuddinS, CottamD, GourashW, HamadG, et al.Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg, 2003; 238:467–484.
15.
BuchwaldH, EstokR, FahrbachK, BanelD, JensenMD, PoriesWJ, et al.Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. Am J Med, 2009; 122:248–256.
16.
ASMBS Clinical Issues Committee. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis, 2012; 8:e21–e26.
17.
BozaC, GamboaC, SalinasJ, AchurraP, VegaA, PérezG. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: A case-control study and 3 years of follow-up. Surg Obes Relat Dis, 2012; 8:243–249.
SakranN, RazielA, GoiteinO, SzoldA, GoiteinD. Laparoscopic sleeve gastrectomy for morbid obesity in 3003 patients: Results at a high-volume bariatric center. Obes Surg, 2016; 26:2045–2050.
20.
HutterMM, SchirmerBD, JonesDB, KoCY, CohenME, MerkowRP, et al.First report from the American College of Surgeons Bariatric Surgery Center Network: Laparoscopicsleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg, 2011; 254:410–420.
21.
BozaC, SalinasJ, SalgadoN, PérezG, RaddatzA, FunkeR, et al.Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: Report of 1,000 cases and 3-year follow-up. Obes Surg, 2012; 22:866–871.
22.
BrethauerSA, KimJ, El ChaarM, PapasavasP, EisenbergD, RogersA, et al.Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis, 2015; 11:489–506.
23.
GillR, BirchD, ShiX, SharmaA, KarmalyS. Sleeve gastrectomy and type 2 diabetes mellitus: A systematic review. Surg Obes Relat Dis, 2010; 6:707–713.
24.
SchauerP, KashyapS, WolskyK, BrethauerS, KirwanJ, PothierC, et al.Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med, 2012; 366:1567–1576.
25.
AbbatiniF, CapocciaD, CasellaG, SoricelliE, LeonettiF, BassoN. Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Surg Obes Relat Dis, 2013; 9:498–502.
26.
AlbanopoulosK, TsamisD, NatoudiM, AlevizosL, ZografosG, LeandrosE. The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: The results of 3 years of follow-up. Surg Endosc, 2016; 30:699–705.
SchauerPR, BhattDL, KirwanJP, WolskiK, BrethauerSA, NavaneethanSD, et al.Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med, 2014
22;370:2002–2013.
29.
SchauerPR, BhattDL, KirwanJP, WolskiK, AminianA, BrethauerSA, et al.Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med, 2017; 376:641–651
30.
AminianA, BrethauerSA, AndalibA, PunchaiS, MackeyJ, RodriguezJ, et al.Can sleeve gastrectomy “cure” diabetes? long-term metabolic effects of sleeve gastrectomyin patients with type 2 diabetes. Ann Surg, 2016; 264:674–681.
CasellaG, SoricelliE, GiannottiD, CollaltiM, MaselliR, GencoA, et al.Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series. Surg Obes Relat Dis, 2016; 12:757–762.
33.
NedelcuM, LoureiroM, SkalliM, GaltierF, JaussentA, DelozeM, et al.Laparoscopic sleeve gastrectomy: Effect on long term remission for morbidly obese patients with type 2 diabetes at 5-year follow up. Surgery, 2017; 162:857–862.
GolombI, Ben DavidM, GlassA, KolitzT, KeidarA. Long-term metabolic effects of laparoscopic sleeve gastrectomy. JAMA Surg, 2015; 150:1051–1057.
36.
PeterliR, WölnerhanssenBK, VetterD, NettP, GassM, BorbélyY, et al.Laparoscopic sleeve gastrectomy versus roux-y-gastric bypass for morbid obesity-3-year outcomes of the prospective randomized swiss multicenter bypass or sleeve study (SM-BOSS). Ann Surg, 2017; 265:466–473.
37.
JimenezA, CasamitjanaR, FloresL, ViaplanaJ, CorcellesR, LacyA, et al.Long-term effect of sleeve gastrectomy and Roux-en- Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg, 2012; 256: 1023–1029.
38.
BrethauerS, AminianA, Romero TalamásH, BatayyahE, MackeyJ, KennedyL, et al.Can diabetes be surgically cured?. Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg, 2013; 258:628–637.
