Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 6:707-713

Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 08/2010; 6(6):707-13. DOI: 10.1016/j.soard.2010.07.011
Source: PubMed


Existing evidence has suggested that bariatric surgery produces sustainable weight loss and remission or cure of type 2 diabetes mellitus (DM). Laparoscopic sleeve gastrectomy (LSG) has garnered considerable interest as a low morbidity bariatric surgical procedure that leads to effective weight loss and control of co-morbid disease. The objective of the present study was to systematically review the effect of LSG on type 2 DM.
An electronic data search of MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database was completed. The search terms used included LSG, vertical gastrectomy, bariatric surgery, metabolic surgery, and diabetes (DM), type 2 DM, or co-morbidities. All human studies, not limited to those in the English language, that had been reported from 2000 to April 2010 were included.
After an initial screen of 3621 titles, 289 abstracts were reviewed, and 28 studies met the inclusion criteria and the full report was assessed. One study was excluded after a careful assessment because the investigators had combined LSG with ileal interposition. A total of 27 studies and 673 patients were analyzed. The baseline mean body mass index for the 673 patients was 47.4 kg/m(2) (range 31.0-53.5). The mean percentage of excess weight loss was 47.3% (range 6.3-74.6%), with a mean follow-up of 13.1 months (range 3-36). DM had resolved in 66.2% of the patients, improved in 26.9%, and remained stable in 13.1%. The mean decrease in blood glucose and hemoglobin A1c after sleeve gastrectomy was -88.2 mg/dL and -1.7%, respectively.
Most patients with type 2 DM experienced resolution or improvement in DM markers after LSG. LSG might play an important role as a metabolic therapy for patients with type 2 DM.

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Available from: Richdeep S Gill,
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    • "In overall, they found that DM had resolved in 66.2% of the patients, improved in 26.9%, and remained stable in 13.1%. The mean decrease in FBS and hemoglobin HbA1c levels after LSG was 88.2 mg/dl and 1.7%, respectively [14]. We have reported nearly the same results among the Palestinian population of the Northern West Bank. "
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    ABSTRACT: Conservative methods for weight loss are usually disappointing. Therefore, surgeries such as Laparoscopic Sleeve Gastrectomy (LSG) should be considered. We aimed to evaluate the outcomes (body mass index; BMI) of LSG among obesity patients in the Northern West Bank. Hospital records were reviewed for all patients who had undergone LSG since 2010 in Arab specialized hospital in Nablus and Palestinian Red Crescent society hospital in Tulkarem. Then, patients have been invited again to participate in the study and asked to self-report further pre-/post-operative measures. The primary study outcome was the change in BMI while secondary outcomes included obesity associated co-morbidities' measures; hypertension (HTN) and diabetes mellitus (DM). The mean age (standard deviation; SD) of the study participants (n = 30; 20 women and 10 men) was 34.06 (10.71) years. The mean (SD) follow-up time was 7.16 (5.05) months. The mean +/- SD of the pre-operative BMI was 47.23 +/- 7.89 kg/m2 while 36.74 +/- 7.74 kg/m2 post-operatively (95% CI for mean differences and P-value; 8.83-12.14 and 0.001). For the clinically diagnosed hypertensive patients, there was a mean (SD) reduction of 27.50 (9.87) mm Hg in systolic pressure (P < 0.026) and 18.33 (13.66) of the diastolic blood pressure (P < 0.042). For diabetics, there were clinically and biologically clear mean (SD) reductions in fasting blood sugar and glycated hemoglobin A1c of about 82.00 (22.70) mg/dl and 1.90 (0.78)%; respectively. Only practicing sports or exercise (no/yes) remained significant with post-operative BMI (regression coefficient B = -7.33; P-value and 95%CI for B; 0.009 and -12.68- -1.98). LSG can significantly improve BMI and could improve or resolve obesity associated co-morbidities like HTN and DM. LSG could be recommended for co-morbid obesity patients who fail to reach beneficial results from a structured weight loss programs.
    BMC Research Notes 02/2014; 7(1):85. DOI:10.1186/1756-0500-7-85
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    • "and 55.9 % (54.1, 57.8) EWL, respectively [5, 22]. Also, an SR by Gill et al. of T2DM patients who underwent sleeve gastrectomy (SG) with a mean 13 months of follow-up noted 47.0 % EWL [66]. "
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    ABSTRACT: We performed a meta-analysis of weight loss and remission of type 2 diabetes mellitus (T2DM) evaluated in randomized controlled trials (RCTs) and observational studies of bariatric surgery vs conventional medical therapy. English articles published through June 10, 2013 that compared bariatric surgery with conventional therapy and included T2DM endpoints with ≥12-month follow-up were systematically reviewed. Body mass index (BMI, in kilogram per square meter), glycated hemoglobin (HbA1C, in degree), and fasting plasma glucose (FPG, in milligram per deciliter) were analyzed by calculating weighted mean differences (WMDs) and pooled standardized mean differences and associated 95 % confidence intervals (95 % CI). Aggregated T2DM remission event data were analyzed by calculating the pooled odds ratio (POR) and 95 % CI. Random effects assumptions were applied throughout; I2 ≥ 75.0 % was considered indicative of significant heterogeneity. Systematic review identified 512 articles: 47 duplicates were removed, 446 failed inclusion criteria (i.e., n < 10 per arm, animal studies, reviews, case reports, abstracts, and kin studies). Of 19 eligible articles, two not focused on diagnosed T2DM and one with insufficient T2DM data were excluded. In the final 16 included papers, 3,076 patients (mean BMI, 40.9; age, 47.0; 72.0 % female) underwent bariatric surgery; 3,055 (39.4; 48.6, 69.0 %) received conventional or no weight-loss therapy. In bariatric surgery vs conventional therapy groups, the mean 17.3 ± 5.7 month BMI WMD was 8.3 (7.0, 9.6; p < 0.001; I2 = 91.8), HbA1C was 1.1 (0.6, 1.6; p < 0.001; I2 = 91.9), and FPG, 24.9 (15.9, 33.9; p < 0.001; I2 = 84.8), with significant differences favoring surgery. The overall T2DM remission rate for surgery vs conventional group was 63.5 vs 15.6 % (p < 0.001). The Peto summary POR was 9.8 (6.1, 15.9); inverse variance summary POR was 15.8 (7.9, 31.4). Of the included studies, 94.0 % demonstrated a significant statistical advantage favoring surgery. In a meta-analysis of 16 studies (5 RCTs) with 6,131 patients and mean 17.3-month follow-up, bariatric surgery was significantly more effective than conventional medical therapy in achieving weight loss, HbA1C and FPG reduction, and diabetes remission. The odds of bariatric surgery patients reaching T2DM remission ranged from 9.8 to 15.8 times the odds of patients treated with conventional therapy. Electronic supplementary material The online version of this article (doi:10.1007/s11695-013-1160-3) contains supplementary material, which is available to authorized users.
    Obesity Surgery 12/2013; 24(3). DOI:10.1007/s11695-013-1160-3 · 3.75 Impact Factor
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    • "Due to its greater efficiency [2], technical simplicity [3], and low complication rates [4], LSG has become more widely accepted as a definitive treatment for morbidly obese patients [5]. In LSG, the stomach is divided vertically, while removing most of the fundus of the stomach and preserving the continuity of the digestive tract [6]. LSG leads to long-term weight loss and improvement or resolution of its associated comorbidities such as diabetes mellitus (DM), hypertension, and hyperlipidemia [7] [8]. "
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    ABSTRACT: Background. Weight loss and reduction in comorbidities can be achieved by longitudinal sleeve gastrectomy (LSG). Existing evidence suggests that LSG resolves or improves hyperlipidemia in morbidly obese patients. The aim of this study was to systematically review the effect of LSG on hyperlipidemia. Methods. A systematic literature search was conducted from English-language studies published from 2000 to 2012 for the following databases: MEDLINE, EMBASE, CINAHL, PubMed, Clinical evidence, Scopus, Dara, Web of Sciences, TRIP, Health Technology Database, Cochrane library, and PsycINFO. Results. A total of 4,211 articles were identified in the initial search, and 4,185 articles were excluded based on the exclusion criteria. Twenty-six studies met the inclusion criteria for this systematic review, involving 3,591 patients. The mean preoperative body mass index (BMI) was 48 ± 7.0 kg/m2 (range 37.2–65.3). The mean postoperative BMI was 35 ± 5.9 kg/m2 (range 26.3–49). The mean percentage of excess weight loss (EWL) was 63.1% (range 37.7–84.5), with a mean followup of 19.1 months (range 6–60). The mean levels of pre and post operative cholesterol were 194.4 ± 12.3 mg/dL (range 178–213) and 181 ± 16.3 mg/dL (range 158–200), respectively. Conclusion. Most patients with hyperlipidemia showed improvement or resolution of lipid profiles after LSG. Based on this systematic review, LSG has a significant effect on hyperlipidemia in the form of resolution or improvement in the majority of patients.
    Journal of obesity 10/2013; 2013(10):643530. DOI:10.1155/2013/643530
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