Gut Hormone Physiological Changes Before and After Sleeve Gastrectomy in Morbidly Obese Diabetic Indian Patients

Vivek Bindal, MS, MRCS, FNB, Parveen Bhatia, MS, FRCS, Sudhir Kalhan, MS, Mukund Khetan, MS, Suviraj John, MS, FNB, Sushant Wadhera, MS. Ganga Ram Institute of Post Graduate Medical Education & Research

Introduction: We propose to analyze and attempt to understand the gut physiology and its metabolic alteration in Type 2 Diabetes Mellitus (T2DM) after Laparoscopic / Robotic Sleeve Gastrectomy (SG).


1. To evaluate the gut metabolic alterations in Indian Diabesitic patients undergoing SG

2. To correlate with the improvement in the anthropometric, diabetic indices and co-morbid conditions leading to betterment of quality of life indices

Methods: This is a prospective study being conducted in Sir Ganga Ram Hospital, New Delhi, India after IRB approval. Prospectively enrolled patients having BMI  > 32.5 Kg/m2  with T2DM underwent Standardized SG. Baseline levels of Glucose, Insulin, C-Peptide were measured in Fasting (F) and Postprandial (PP) states. HbA1C levels are evaluated and HOMA-IR index calculated. Baseline fasting and PP levels of GHRELIN, GLP-1 & PYY are evaluated.

Results: A total of 32 patients have been enrolled in study thus far. The preliminary results show a significant decrease in BMI and a significant (p>0.001) correlation is found between fasting blood glucose-, insulin-levels with HbA1c. Furthermore, C-peptide decreases significantly within 1 month but increases as expected by 1 year. Also, as levels of Ghrelin decrease, GLP1 was observed to increase and PYY1 was also observed to decrease over a period of 6 months. Further Gut hormone data analysis is under process.

Conclusions: Our  preliminary data shows that SG even though traditionally believed to be a restrictive procedure, does lead to metabolic  alterations by producing changes in the gut hormones and resetting the deranged Gut- Endocrine Axis.

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