Type 2 Diabetes Mellitus and the Metabolic Syndrome Following Sleeve Gastrectomy in Severely Obese Subjects
ABSTRACT Data on the effectiveness of sleeve gastrectomy in improving or resolving type 2 diabetes mellitus (T2DM) and the metabolic syndrome (MS) are scarce.
A twelve-month prospective study on the changes in glucose homeostasis and the MS in 91 severely obese T2DM subjects undergoing laparoscopic SG (SG; n = 39) or laparoscopic Roux-en-Y gastric bypass (GBP; n = 52), matched for DM duration, type of DM treatment, and glycemic control was conducted.
At 12 months after surgery, subjects undergoing SG and GBP lost a similar amount of weight (%EBL: SG: 63.00 +/- 2.89%, BPG: 66.06 +/- 2.34%; p = 0.413). On that evaluation, T2DM had resolved, respectively, in 33 out of 39 (84.6%) and 44 out of 52 (84.6%) subjects after SG and GBP (p = 0.618). The rate of resolution of the MS (SG: 62.2%, BPG: 67.3%; p = 0.392) was also comparable. A shorter DM duration (p < 0.05), a DM treatment not including pharmacological agents (p < 0.05), and a better glycemic control (p < 0.05), were significantly associated with T2DM resolution in both surgical groups. Weight loss was not associated with T2DM resolution after SG or GBP, but was associated with resolution of the MS following the two surgical procedures (p < 0.05).
Our data show that at 12 months after surgery, SG is as effective as GBP in inducing remission of T2DM and the MS. Furthermore, our data suggest that SG and GBP represent a successful an integrated strategy for the management of the different cardiovascular risk components of the MS in subjects with T2DM.
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ABSTRACT: Laparoscopic sleeve gastrectomy (LSG) for morbid obesity is gaining in popularity as it offers several advantages over laparoscopic Roux-en-Y gastric bypass (LRYGBP), but comparative data between these two procedures have rarely been reported. This case control study compared the incidence of low-grade systemic inflammation, insulin resistance, anthropometrics, resting energy expenditure and metabolic syndrome in 30 patients undergoing LRYGBP and 30 patients undergoing LSG, matched for age, sex, body mass index (BMI), and glycosylated hemoglobin (HbA1c). At 1-year after surgery, the percent of excess weight loss was 67.8±20.9 for LRYGBP and 61.6±19.4 for LSG. Patients undergoing LRYGBP showed significantly lower plasma levels of C-reactive protein (3.3±2.7mg/dL vs. 5.3±3.9mg/dL; P<0.05), waist circumference (97.4±16.0 vs. 105.5±14.7cm; P<0.05), total cholesterol (4.6±1.0 vs. 5.7±0.9mmol/L; P<0.01) and LDL cholesterol (2.6±0.8 vs. 3.6±0.8mmol/L; P<0.01). Insulin resistance (HOMA index 1.6±1.0 after LRYGBP vs. 2.3±2.4 after LSG), resting energy expenditure (1666.7±320.5 after LRYGBP vs. 1600.4±427.3Kcal after LSG) and remission of metabolic syndrome (92.9% after LRYGBP vs. 80% after LSG) were not different between the two groups. In this study, patients undergoing LRYGBP demonstrated significantly improved lipid profiles, decreased systemic low-grade inflammation compared with those undergoing LSG at 1-year follow-up.Journal of Visceral Surgery 09/2013; 150(4). DOI:10.1016/j.jviscsurg.2013.08.005 · 1.32 Impact Factor
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ABSTRACT: Background The effective treatment of postoperative anemia and nutritional deficiencies is critical for the successful management of bariatric patients. However, the evidence for nutritional risk or support of bariatric patients remains scarce. Objectives To assess current evidence of the association between 2 methods of bariatric surgery—sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB)—and postoperative anemia and nutritional deficiencies. Settings Meta analysis Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for English-language studies using a list of keywords. Reference lists from relevant review articles were also searched. In our meta-analysis, we included studies with a duration of >12 months, those comparing SG with RYGB, and those with available outcome data for postoperative anemia and iron and vitamin B12 deficiencies. Of 36 potentially relevant studies, 9 met the inclusion criteria. Data were combined by means of a fixed-effects model or random-effects model. Results Compared with the SG group, the odds ratio for postoperative vitamin B12 deficiency in the RYGB group was 3.55 (95% confidence interval, 1.26–10.01; P < 0.001). In the subgroup analysis, studies in which prophylactic iron or vitamin B12 was administered lost significance in the odds ratio for postoperative vitamin B12 deficiency. Conclusions Our findings suggest that SG is more beneficial than RYGB with regard to postoperative vitamin B12 deficiency risk, whereas the 2 methods are comparable with regard to the risk of postoperative anemia and iron deficiency. Postoperative prophylactic iron and B12 supplementation, in addition to general multivitamin and mineral supplementation, is recommended based on the comparable deficiency risk of the 2 methods, as indicated by subgroup analysis.Surgery for Obesity and Related Diseases 01/2013; 10(4). DOI:10.1016/j.soard.2013.12.005 · 4.94 Impact Factor
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ABSTRACT: Bariatric surgery is the most efficacious procedure for eliciting weight loss in humans, and many patients undergoing the procedure experience significant lessening of their symptoms of type-2 diabetes in addition to losing weight. We have adapted two bariatric surgical procedures commonly employed in humans to a rat model to begin to understand the mechanisms underlying the improvements in energy homeostasis. Young adult male rats received either roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG) and were assessed for body weight, food intake and parameters of glucose homeostasis over a 28-week period. Control rats received either a sham surgical procedure or else were unoperated. RYGB and VSG had comparable beneficial effects relative to controls. They ate less food and lost more weight, and they both had improved glucose parameters. The most intriguing aspect of the findings is that the two surgical procedures had such similar effects in spite of quite different rearrangements of the gastrointestinal system.Physiology & Behavior 06/2011; 105(1):120-3. DOI:10.1016/j.physbeh.2011.05.026 · 3.03 Impact Factor