Article

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: 4.94). 07/2011; 8(1):20-4. DOI: 10.1016/j.soard.2011.06.015
Source: PubMed

ABSTRACT 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 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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    • "Since it is known that good glycemic control decreases long-term morbidity, a substantial reduction of mortality and morbidity can be expected [6,10]. Several randomized controlled trials (RCTs) have focused on diabetes remission, assessed mostly by HbA1c and fasting glucose, showing a remission of T2DM [21,26,27]. However, diabetes-associated morbidity and mortality were not the subjects of those studies because the follow-up period of 12 to 24 months was too short to assess them as endpoints. "
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    ABSTRACT: Background Type 2 diabetes mellitus (T2DM) is a disease with high prevalence, associated with severe co-morbidities as well as being a huge burden on public health. It is known that glycemic control decreases long-term morbidity and mortality. The current standard therapy for T2DM is medical treatment. Several randomized controlled trials (RCTs) performed in obese patients showed remission of T2DM after bariatric surgery. Recent RCTs have shown bariatric procedures to produce a similar effect in non-morbidly and non-severely obese, insulin-dependent T2DM patients suggesting procedures currently used in bariatric surgery as new therapeutical approach in patients with T2DM. This study aims at investigating whether Roux-en-Y gastric bypass (RYGB) is an efficient treatment for non-severely obese T2DM patients in terms of preventing long-term complications and mortality. Methods The DiaSurg 2 trial is a multicenter, open randomized controlled trial comparing RYGB including standardized medical treatment if needed to exclusive standardized medical treatment of T2DM (control group). The primary endpoint is a composite time-to-event endpoint (cardiovascular death, myocardial infarction, coronary bypass, percutaneous coronary intervention, non-fatal stroke, amputation, surgery for peripheral atherosclerotic artery disease), with a follow-up period of 8 years. Insulin-dependent T2DM patients aged between 30 and 65 years will be included and randomly assigned to one of the two groups. The experimental group will receive RYGB and, if needed, standardized medical care, whereas the control group will receive exclusive standardized medical care, both according to the national treatment guidelines for T2DM. Statistical analysis is based on Cox proportional hazards regression for the intention-to-treat population. Assuming a loss to follow-up rate of 20%, 200 patients will be randomly allocated to the comparison groups. A total sample size of n = 400 is sufficient to ensure 80% power in a two-tailed significance test at alpha = 5%. Discussion The DiaSurg2 trial will yield long-term data (8 years) on diabetes-associated morbidity and mortality in patients with insulin-dependent T2DM receiving either RYGB or standardized medical care. Trial registration The trial protocol has been registered in the German Clinical Trials Register DRKS00004550.
    Trials 06/2013; 14(1):183. DOI:10.1186/1745-6215-14-183 · 2.12 Impact Factor
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