Type 2 Diabetes Mellitus and the Metabolic Syndrome Following Sleeve Gastrectomy in Severely Obese Subjects

Obesity Unit, Hospital Clinic Universitari, Villarroel 170, Barcelona, Spain.
Obesity Surgery (Impact Factor: 3.75). 09/2008; 18(9):1077-82. DOI: 10.1007/s11695-008-9547-2
Source: PubMed


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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    • "The retrospective clinical studies scored between 7 and 8 out of a maximum score of 10, while the prospective clinical studies scored between 7 and 11 out of a maximum score of 13. One study was subsequently excluded because of deficient reliability, leaving 11 studies in the final analysis [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26]. "
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    ABSTRACT: Until recently, Roux-en-Y gastric bypass (RYGB) was the most frequently performed procedure in bariatric surgery. In the last decade, sleeve gastrectomy (SG) has emerged as a more popular, simpler, and less morbid form of bariatric surgery. This study compares the efficacy of SG and RYGB for the treatment of type 2 diabetes mellitus (T2DM). Systemic review and meta-analysis. MEDLINE, EMBASE, and the Cochrane Library were searched for entries up to December 2013. Search terms included "Sleeve gastrectomy," "Gastric bypass," and "Type 2 diabetes mellitus." The chosen articles described both "Sleeve gastrectomy" and "Gastric bypass" and included over 1 year of follow-up data. Data analysis was performed with Review Manager 5.2 and SPSS version 20. The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the SG group and 428 patients in the RYGB group. In nonrandomized clinical studies, SG displayed similar efficacy in remission of T2DM compared with the standard RYGB. In the RCTs, SG had a lower effect than that of RYGB. T2DM remission was not correlated with the percent of excess weight loss for either procedure. Based on the current evidence, SG has a similar effect on T2DM remission as RYGB. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    Surgery for Obesity and Related Diseases 03/2015; DOI:10.1016/j.soard.2015.03.001 · 4.07 Impact Factor
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    • ": LRYGBP was followed by a higher remission rate of T2D (93% vs. 47%) and resulted in a lower BMI, waist circumference and blood lipid levels than LSG [21]. The difference in the type of patients studied and the fact that the course of the MetS was only a secondary outcome measure may at least partially account for the discrepancies in results between these two studies [20] [21]. Moreover, in our study, the rate of resolution of MetS was very high in both groups of patients (93% for LRYGBP and 80% for LSG). "
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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 · 1.75 Impact Factor
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    • "Although it would be most interesting to evaluate lipid metabolism before surgery, then at the time point of the most rapid weight loss and again at a new steady state, this is difficult to perform since the time course of weight loss is highly variable. In comparing our study to previous studies it should also be acknowledged that our subjects received a sleeve gastrectomy, a form of bariatric surgery for which only minimal data on lipid metabolism is available [20,24,25]. Thus, it could be hypothesized that the method of surgery has an impact on lipid levels. "
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    ABSTRACT: Background Obesity is associated with abnormal fasting and postprandial lipids, which may link obesity with atherosclerosis. We explored fasting and postprandial lipids in morbidly obese patients treated with sleeve gastrectomy and in control subjects. Methods After fasting for 12 h 15 morbidly obese patients (BMI 51.4±6.5 kg/m2, 43.7±12.6 years) received a standardized oral fat load before and 3 months after bariatric surgery (sleeve gastrectomy). Controls (n=9, BMI 23.1±1.4 kg/m2) were studied once. Plasma was obtained fasting and then postprandially every 2 h for 8 h. Triglycerides (TG), chylomicron-TG (CM-TG), VLDL/chylomicron-remnant (VLDL/CR)-TG, cholesterol, LDL-cholesterol, VLDL/CR-cholesterol and HDL-cholesterol were isolated by ultracentrifugation at each time point. Postprandial values were expressed as area under the curve (AUC) and incremental area under the curve (iAUC). In addition, fasting glucose and insulin values and HOMA-IR-Index was measured (n=14). Results Compared to controls morbidly obese patients had elevated TG and slightly altered postprandial lipids. Following surgery (weight loss 23.4 kg±6.2 kg; p<0.001) fasting TG (−19.1%; p=0.04), VLDL/CR-TG (−20.0%; p=0.05) decreased significantly, while fasting cholesterol, VLDL-, HDL- and LDL-cholesterol did not change. AUC and iAUC decreased significantly for VLDL/CR-TG (−20.4%, p=0.04 and −38.5%, p=0.04, respectively). Neither fasting nor postprandial changes correlated with the change in weight. In patients with preoperatively elevated TG (>150 mg/dl) a similar pattern was observed. Fasting insulin and HOMA were reduced significantly (−51.9%; p=0.004 and −47.9%; p=0.011). Conclusions Three months after sleeve gastrectomy fasting and postprandial lipoprotein metabolism and glucose metabolism is improved in morbidly obese patients. The potential mechanisms may relate to decreased caloric intake but also to hormonal changes.
    Lipids in Health and Disease 06/2013; 12(1):82. DOI:10.1186/1476-511X-12-82 · 2.22 Impact Factor
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