Can Sleeve Gastrectomy “Cure” Diabetes? Long-term Metabolic Effects of Sleeve Gastrectomy in Patients With Type 2 Diabetes

Aminian, Ali; Brethauer, Stacy A.; Andalib, Amin; Punchai, Suriya; Mackey, Jennifer; Rodriguez, John; Rogula, Tomasz; Kroh, Matthew; Schauer, Philip R.

doi:10.1097/sla.0000000000001857

Cited by 102 publications

(42 citation statements)

References 41 publications

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“…Despite that there were no cases of complete remission of diabetes. Similar results and very rare diabetes remission was presented by Aminian (19).…”

Section: Discussionsupporting

confidence: 76%

Laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 patients—single center early experience

et al. 2016

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Background: In recent years, laparoscopic sleeve gastrectomy (LSG) has become one of the most commonly used primary bariatric procedures for morbid obesity. While laparoscopic Roux-en-Y gastric bypass (LRYGB) has well documented positive clinical influence on type 2 diabetes, the role of LSG in diabetes treatment is debatable. The main aim of this study is to present our early experience in LSG as a method of bariatric treatment in patients with type 2 diabetes or abnormalities in glucose homeostasis.Methods: Prospectively collected data of patients operated for morbid obesity at the 2nd Department of Surgery. The study was designed to assess the influence of LSG on type 2 diabetes and glucose homeostasis.The primary endpoint was the diabetes type 2 remission. Secondary endpoint was the change of glucose metabolism parameters after LSG. Patients were assessed preoperatively and allocated to two groups: group 1-with any preoperative abnormalities in glucose homeostasis (prediabetes, diabetes) and group 2-with non-elevated fasting glucose level. During follow-up (6 months after surgery) all glucose homeostasis parameters were analyzed again. One hundred and thirty-six patients after LSG were enrolled in the study (90 females, 46 males; mean age 40.5±9.9 years). Preoperative abnormalities in glucose homeostasis were confirmed in 64 (47%) patients. Twenty (15%) patients in this group had diabetes. Results:We observed significant reduction of body mass index (BMI) after surgery. Mean percent of EBMIL for all groups after 6 months from surgery was 59.90% (46.75-69.28%). There were no full remissions after surgery in patients with preoperative diabetes. We found significant improvement in biochemical markers of glucose homeostasis. We observed significant reduction of HbA1c% after surgery in both groups. The level of postoperative HbA1c% was related to BMI loss after surgery.Conclusions: LSG leads to significant improvement in biochemical glucose homeostasis and can be considered as a method of treatment in morbidly obese patients with glucose metabolism abnormalities. LSG as a method of treatment for patients with clinical type 2 diabetes still needs some further observation.

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“…Despite that there were no cases of complete remission of diabetes. Similar results and very rare diabetes remission was presented by Aminian (19).…”

Section: Discussionsupporting

confidence: 76%

Laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 patients—single center early experience

et al. 2016

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“…In another study with a 10 year follow-up period, about half of the patients with VSG suffered from significant weight regain and many of these were converted to RYGB after only about 3 years [17]. Furthermore, in a five year follow-up study, long-term relapse after initial remission of type 2 diabetes occurred in over 40% of patients [31]. …”

Section: Discussionmentioning

confidence: 99%

RYGB Produces more Sustained Body Weight Loss and Improvement of Glycemic Control Compared with VSG in the Diet-Induced Obese Mouse Model

et al. 2017

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Objective To compare the effects of murine models of vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) surgery on body weight, body composition, food intake, energy expenditure, and glycemic control. Background Weight regain and type-2 diabetes relapse has been reported in a significant proportion of VSG patients in some studies, but definitive conclusions regarding the long-term comparative effectiveness of VSG and RYGB are lacking both in humans and rodent models. Methods VSG, RYGB, and sham surgery was performed in high-fat diet-induced obese mice and the effects on body weight and glycemic control were observed for a period of 12 weeks. Results After the initial weight loss, VSG mice regained significant amounts of body weight and fat mass that were only marginally lower than in sham-operated mice. In contrast, RYGB produced sustained loss of body weight and fat mass up to 12 weeks, and drastically improved fasting insulin and HOMA-IR compared with sham-operated mice. Using weight-matched control groups we also found that the adaptive hypometabolic response to weight loss was blunted by both VSG and RYGB, and that despite large weight/fat regain, fasting insulin and HOMA-IR were markedly improved, but not reversed, in VSG mice. Conclusions VSG is less effective to lastingly suppress body weight and improve glycemic control compared with RYGB in mice. Given similar observations in many human studies, the run towards replacing RYGB with VSG is premature and should await carefully controlled randomized long term trials with VSG and RYGB.

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“…The improvement of T2DM occurred soon after surgery, even without significant weight loss yet being achieved, and this fact could be attributed to hormonal changes, such as increased GLP-1 secretion or decreased ghrelin[6]. The long-term effects of LSG on T2DM evolution are under continuous evaluation, and Aminian et al[42] recently reported a 44% of long-term relapse of T2DM after initial remission and continuous complete remission for ≥ 5 years (“cure”) was achieved in only 3% of the patients. LSG and RYGB showed comparable remission rates of T2DM in a long-term observational study[18], but a meta-analysis including 6526 patients confirmed that RYGB achieved a higher diabetes remission rate (HR = 1.49, 95%CI: 1.04-2.12)[16].…”

Section: Discussionmentioning

confidence: 99%

Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

Hoyuela¹

2017

WJGS

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AIMTo prospectively evaluate the postoperative morbi-mortality and weight loss evolution of patients who underwent a laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure during 5 years of follow-up.METHODSSince 2006, data from patients undergoing a highly restrictive primary LSG have been prospectively registered in a database and analysed. Preoperative co-morbid conditions, operating time, hospital stay, early and late complications rate and evolution of weight loss after 5 years of follow-up were analysed.RESULTSA total of 156 patients were included, 74.3% of whom were women. The mean age was 43.2 ± 13.1 years and the mean body mass index (BMI) was 41.5 ± 7.9 kg/m2. Seventy patients (44.8%) presented a BMI under 40 kg/m2. The mortality rate was 0%. The leakage rate was 1.2%, and the total 30-d morbidity rate was 5.1% (8/156). With a mean follow-up of 32.7 ± 28.5 (range 6-112) mo, the mean percent of excess of weight loss (%EWL) was 82.0 ± 18.8 at 1 year, 76.7 ± 21.3 at 3 years and 60.3 ± 28.9 at 5 years. The mean percent of excess of BMI loss (%EBMIL) was 94.9 ± 22.4 at 1 year, 89.4 ± 27.4 at 3 years and 74.8 ± 29.4 at 5 years. Patients with preoperative BMI less than 40 kg/m2 achieved greater weight loss than did the overall study population. Diabetes remitted in 75% of the patients and HTA improved in 71.7%. CPAP masks were withdrawn in all patients with obstructive sleep apnoea.CONCLUSIONLSG built with a narrow 34 F bougie and starting 3 cm from the pylorus proved to be safe and highly effective in terms of weight loss as a stand-alone procedure, particularly in patients with a preoperative BMI lower than 40 kg/m2.

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Can Sleeve Gastrectomy “Cure” Diabetes? Long-term Metabolic Effects of Sleeve Gastrectomy in Patients With Type 2 Diabetes

Abstract: LSG can significantly improve cardiometabolic risk factors including glycemic status in T2DM. Long-term complete remission and "cure" of T2DM, however, occur infrequently.

Cited by 102 publications

References 41 publications

Laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 patients—single center early experience

Laparoscopic sleeve gastrectomy for the treatment of diabetes mellitus type 2 patients—single center early experience

RYGB Produces more Sustained Body Weight Loss and Improvement of Glycemic Control Compared with VSG in the Diet-Induced Obese Mouse Model

Five-year outcomes of laparoscopic sleeve gastrectomy as a primary procedure for morbid obesity: A prospective study

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