Type 2 Diabetes Remission in Obese Patients After Laparoscopic Sleeve Gastrectomy

Federico Moser, MD, German Viscido, MD, Alvaro Alcaraz, MD, Veronica Gorodner, MD, Lucio Obeide, MD. Hospital Privado de Cordoba.

Introduction: there is clear evidence that type 2 diabetes obese patients are more likely to achieve diabetes control after bariatric surgery than those patients medically treated. The majority of the reports are based on gastric bypass or adjustable gastric band results; however, short term outcomes after laparoscopic sleeve gastrectomy (LSG) are encouraging. Our goal was to evaluate midterm results in patients who underwent LSG at our Institution.

Methods and Procedures: this was a retrospective review of prospectively collected data. Patients with type 2 diabetes who underwent LSG were included in the study. Diabetes remission criteria were: postoperative fasting glucose < 126 mg/dl, hemoglobin A1c < 6 %, and oral hypoglycemic agents (OHA) discontinuation. Lipid profile was also assessed. Xlstat software was used to perform the statistical analysis.

Results: Between January 2006 and February 2013, 101 patients underwent LSG at our Institution. There were 42 (42%) men, mean age was 48 yo. Initial BMI was 46 kg/m2. Mean time from diabetes diagnosis was 4,9 years (range1-31). Mean preop hemoglobin A1c was 7,7%. Previous treatment: insulin 13 (13%), OHA 80 (79%), and diet 8 (8%). Mean follow up was 37 months. Percentage excess weight loss (%EWL) at 1, 6, 12, and 24 months was 38%, 60%, 60%, and 62% respectively. BMI at 1, 6, 12, and 24 months was 39, 34, 35, and 34 respectively. There was no statistical difference in %EWL when comparing patients with remission vs. non remission. Diabetes remission was seen in 72 (71%) patients, and improvement in 25 (25%); in 4 (4%) patients remained unchanged. The longer history of diabetes, and indication of insulin therapy were significantly related to decrease chances of remission (p 0.018 and 0.001 respectively); thus, remission was observed in 23% of patients on insulin therapy, and 78% of patients without insulin (p 0.001). Pre and postop laboratory results were as follows:

Fasting glucose138±4598±22<0.001
Cholesterol total185175NS
HDL (male/female)38/4446/51NS

CONCLUSION: these data showed that, midterm results after LSG were excellent, not only in regards to weight loss, but also for type 2 diabetes control. There was no statistically significant difference when pre and postop total cholesterol, LDL, and HDL were compared. However triglycerides were significantly decreased after the operation. Long term follow up will be necessary to better define the role of LSG on metabolic syndrome.

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