Effect of sleeve gastrectomy on control of Type 2 Diabetes Mellitus in our series

Nandakishore Dukkipati, MD, Deepti Thakkar. LivlifeHospitals

Introduction:  An estimated 80% of Type 2 Diabetes is related to Obesity. Weight loss induced by bariatric surgery is a major factor of diabetes improvement . Our aim in this study was to see the effect of Laparoscopic Sleeve Gastrectomy on control and remission of Diabetes and also to see the difference in improvement of  Diabetes based on distance of resection from the pylorus.

Materials and methods: All LSG patients between Jan 2012 to Dec 2014, who were diagnosed cases of type 2 Diabetes preoperatively, were followed up and their current BMI, diabetic medication usage, fasting blood glucose and HbA1c  levels were documented. Remission of diabetes was defined as discontinuation of diabetic medications, concurrent with normalization of fasting glucose (<110mg/dl)  and HbA1c (<=6) . Improvement was defined as either a decrease in HbA1C level or a reduction in the antidiabetic treatment. We measured and recorded the Distance of resection from Pylorus during surgery for all patients.

Results:35 Diabetic obese patients underwent Laparoscopic gastric sleeve between Jan 2012 and Dec 2014. 12 were females and 23 were males. Their average age was 45 years and average BMI was 42.23kg/m2.  8 patients were on Insulin and remaining 27 were on Oral Hypoglycemic agents(OHA) before surgery.  Post operatively, 27 out of 35 i.e. 78% patients were off all medications for Diabetes.  6 patients were still on OHAs and only 2 patients still need Insulin for control of blood sugars. However all patients witnessed improvement in sugar levels with a reduction in dosage of medications. 20 out of 35 patients i.e. 57.14% patients had complete remission of Diabetes. Resection distance from pylorus less than 2cm was found to significantly affect remission rate (p=0.034). Also patients with less than 2 yrs diabetes  were significantly more likely to have remission than those with more than 2 yrs Diabetes history (p=0.001). However, percentage excess weight loss did not affect remission rates.

Conclusions: Laparoscopic Gastric Sleeve surgery can induce a significant and sustainable remission and improvement of T2DM in severely obese patients. This study is one of the few studies where antral resection distance was co-related to improvement of Diabetes. However this study is retrospective with a small sample size and a short follow up period. More prospective studies with larger sample size and longer follow up period are required to confirm these results.

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