Type 2 diabetes in obese patients with body mass index of 3035 kg/m 2: Sleeve gastrectomy versus medical treatment

Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University La Sapienza, Rome, Italy.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 07/2011; 8(1):20-4. DOI: 10.1016/j.soard.2011.06.015
Source: PubMed


Type 2 diabetes mellitus (T2DM) and obesity are diseases of epidemic proportions. Long-term realistic weight loss by nonsurgical methods has a variable effect on glycemic control, and only a proportion of patients with T2DM have a worthwhile response. Laparoscopic sleeve gastrectomy (LSG) has been proposed as an advantageous bariatric procedure for patients with a lower body mass index (BMI). Our objective was to compare the effects of LSG and medical therapy on patients with T2DM and a BMI of <35 kg/m(2).
A total of 18 nonmorbidly obese patients with T2DM, diagnosed according to the American Diabetes Association guidelines, were consecutively enrolled. Of these patients, 9 underwent LSG (group A) and 9 underwent conventional medical therapy (group B). The 2 groups were matched for BMI, glycated hemoglobin (HbA1c) and C-peptide levels, pretrial therapy type, and number of patients with a T2DM duration of >10 years.
In group A, T2DM resolution was achieved in 8 (88.8%) of the 9 patients (T2DM duration 5.2 yr). Hypertension was controlled in all 8 of 9 patients. Dyslipidemia was corrected. In 1 patient, obstructive sleep apnea syndrome improved. In group B, all 9 patients continued to have T2DM and required hypertensive and hypolipemic therapies throughout the observation period. At baseline, 3 patients were affected by obstructive sleep apnea syndrome and remained affected 1 year later.
The results of the present study have confirmed the efficacy of LSG in the treatment of nonmorbidly obese T2DM patients, with a remission rate of 88.8% without undesirable excessive weight loss. The results in this group of patients add to those obtained by us in patients with a BMI >35 kg/m(2).

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    • "In a meta-analysis [8] that analyzed 27 studies and 673 patients, diabetes remission was reported in 66.2% of cases and improvement was reported in 26.9% of cases. In our previous studies diabetes remitted in 80% of patients [9] [10], results that have been predominantly confirmed by a recently published meta-analysis by Yu et al. [11]. "
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    ABSTRACT: The study was carried out on type 2 diabetic obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients underwent regular glycemic controls throughout 3 years and all patients were defined cured from diabetes according to conventional criteria defined as normalization of fasting glucose levels and glycated hemoglobin in absence of antidiabetic therapy. After 3 years of follow-up, Continuous Glucose Monitoring (CGM) was performed in each patient to better clarify the remission of diabetes. In this study, we found that the diabetes resolution after LSG occurred in 40% of patients; in the other 60%, even if they showed a normal fasting glycemia and A1c, patients spent a lot of time in hyperglycemia. During the oral glucose tolerance test (OGTT), we found that 2 h postload glucose determinations revealed overt diabetes only in a small group of patients and might be insufficient to exclude the diagnosis of diabetes in the other patients who spent a lot of time in hyperglycemia, even if they showed a normal glycemia (<140 mg/dL) at 120 minutes OGTT. These interesting data could help clinicians to better individualize patients in which diabetes is not resolved and who could need more attention in order to prevent chronic complications of diabetes.
    Journal of Diabetes Research 05/2015; 2015:1-8. DOI:10.1155/2015/674268 · 2.16 Impact Factor
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    • ") . In a small series from Italy , nine diabetic patients with a BMI of 28 – 35 kg / m 2 were submitted to SG , with favorable results regarding diabetes control in comparison to a control group , P a g e | 32 one year after surgery ( Abbatini et al . , 2012 ) . Two studies from Chile including 30 and 31 patients with mild obesity submitted to GB showed similar results with remission rates of 65% and 93 . 6% , after 2 and 3 years of follow - up ( Boza et al . , 2011a ; Lanzarini et al . , 2013 ) . However , two studies from Brazil revealed conflicting results after GB . A less favorable out"
    02/2015, Degree: PhD, Supervisor: Francisco Castro e Sousa
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    • "However, the indications of bariatric surgery were limited to these patients whose BMI > 35 kg/m2 by this organization. Actually, patients (BMI < 35 kg/m2) who had received the treatment of bariatric surgery achieved ideal goals [19, 20]. Thus, we think that it is necessary to perform this meta-analysis for subjects (BMI < 35 kg/m2) who had received bariatric surgery. "
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    ABSTRACT: Objective: To assess the effects of bariatric surgery versus medical therapy for type 2 diabetes mellitus. Methods: The Cochrane library, PubMed, Embase, Chinese biomedical literature database, and Wanfang database up to February 2012 were searched. The literature searches strategies contained terms ("diabetes*", "surg*", and "medic*" were used), combined with the medical subject headings. Randomized controlled trails (RCTs) of frequently used bariatric surgery for obese patients with type 2 diabetes were included. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results: Three randomized controlled trials (RCTs) involving 170 patients in the bariatric surgery groups and 100 patients in the medical therapy group were selected. Compared with medical therapy, bariatric surgery for type 2 diabetes can significantly decrease the levels of HbA1c, FBG, weight, triglycerides, and the dose of hypoglycemic, antihypertensive, and lipid-lowering medicine, while increasing the rate of diabetes remission (RR = 9.74, 95%CI, (1.36, 69.66)) and the levels of high-density lipoprotein. However, there are no statistical differences in serious adverse events between the surgical and medical groups (RR = 1.23, 95%CI, (0.80, 1.87)). Conclusions: Surgical procedures were more likely to help patients achieve benefits than medical therapy alone. Further intensive RCTs of high-quality, multiple centers and long-term followup should be carried out to provide more reliable evidence.
    07/2013; 2013(11):410609. DOI:10.1155/2013/410609
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