Franco J Signorini, MD1, German R Viscido, MD1, Veronica Gorodner, MD2, Luciano Arocena, MD1, Lucio R Obeide, MD1, Federico Moser, MD1. 1Hospital Privado Universitario de Córdoba, 2Unidades Bariatricas, Buenos Aires
INTRODUCTION: Diabetes (DBT) improvement or remission associated to bariatric surgery have been shown by several studies. Data about the recurrence of DBT after surgery remains scarce and very little information can be collected regarding sleeve gastrectomy (SG). The main goal of our study was to determine the incidence of durable remission of DBT after sleeve gastrectomy and factors associated with DBT recurrence.
METHODS AND PROCEDURES: A retrospective study of all patients (n=47) with DBT who had undergone primary LSG at a single institution and had more than eight years of follow-up with complete laboratory data available was perfomed. Patients with inadequate weight loss were compared with patients with adequate weight loss. Patients with long time of diabetes evolution were also compared with those with less than 10 years of evolution. Finally, patients that needed insulin for glycemic control were analyzed separately.
RESULTS: After SG, all patients had rapid improvement of their DBT. 83% achieved complete resolution and 17% registered an improvement in their metabolic control within the first year. The average follow-up time was 8.8 years. At this point, the mean post-operative %EWL was 51± 19.39%, HbA1c 6.45± 1.28% and FG 118.7± 27.75 mg/dl. 31% of the patients with initial resolution after surgery experienced recurrence. 6 out of the 8 (75%) patients who registered an initial improvement worsened their metabolic control. Those who recurred or worsened had an inadequate mean %EWL (46%) and 67% needed more than one drug preoperatively for their DBT control. The results of a comparison of patients with adequate weight loss (n=25) versus inadequate weight loss (n=22) reported a %EWL of 66,44% (± 11.38) and 34,04% (± 11.25) respectively (p?0.001). Statistical difference was obtained when the number of patients with remission or improvement was compared with those with recurrence or worsening among this groups (p?0.0255). Patients with long time DBT evolution (n=14) were compared with those with short time DBT evolution (n=33): 50% vs 37% of patients recurred respectively (p?0.704). All the patients who required insulin (n=5), had initial remission or improvement. 60% recurrence or worsening was registered in the long term, none of them required insulin and their DBT could be managed with drugs and even without medication.
CONCLUSION: Sleeve gastrectomy significantly improves diabetes control and appear to alter the trajectory of the disease without resulting in a permanent cure. The result seems to be assosiated to weight loss and insulin requierements.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95459
Program Number: P174
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster