Original article
Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus

https://doi.org/10.1016/j.soard.2009.06.007Get rights and content

Abstract

Background

To prospectively evaluate the efficacy and safety of laparoscopic sleeve gastrectomy (LSG) in Indian subjects with type 2 diabetes mellitus and a body mass index >33 kg/m2 in a tertiary care hospital in Pune, India. Morbid obesity associated with type 2 diabetes mellitus has many health implications. A definitive long-term strategy is needed to control obesity and its deleterious effects. LSG is one such approach.

Methods

The patients who underwent LSG were followed up until the end of 1 year after surgery. The change in hemoglobin A1c levels, waist circumference, total body weight, and the use of oral hypoglycemic agents and insulin were studied.

Results

A total of 53 patients (24 men and 29 women, age 46.5 ± 8.7 years, body mass index 45.2 ± 9.3 kg/m2, waist circumference 117 ± 18 cm, and hemoglobin A1c 8.4% ± 1.6%) fulfilled the entry criteria and underwent LSG. Before LSG, 48 patients (79%) required antidiabetic medication (oral hypoglycemic agents and insulin) and 5 managed their diabetes with diet control. At 1 month after LSG, 39 (81.2%) of 48 patients no longer required antidiabetic medications and had achieved euglycemia with diet control alone. The use of antidiabetic medications was reduced in 9 (18.8%) of 52 patients. At 1 year, euglycemia was observed in 51 patients (96.2%) without medication and 2 (3.8%) of the 53 patients had reduced their medication dosage.

Conclusion

LSG is an effective adjunct in the treatment of type 2 diabetes mellitus in obese individuals. It appears that improvement in glycemic control is achieved even before weight reduction, and the possible mechanisms explaining this need further investigation.

Section snippets

Methods

The study was conducted at the Ruby Hall Medical Center, a tertiary care hospital located in Pune, India from January 2004 to September 2007. The institutional ethics committee approved this prospective study. The patients were screened for participating in the present study after providing written informed consent. The inclusion criteria defined obesity as a BMI of ≥37.5 kg/m2 or ≥32.5 kg/m2 in the presence of obesity-related co-morbidities [4], [12], [13].

The study subjects were required to

Results

A total of 53 patients fulfilled the entry criteria and underwent LSG. Of the 53 patients, 24 were men and 29 were women. Their mean age was 46.5 ± 8.7 years, mean BMI was 45.2 ± 9.3 kg/m2, mean waist circumference was 117.8 ± 18.0 cm, and mean HbA1c was 8.4% ± 1.6%. The mean duration of T2DM was 4.2 ± 5.0 years, and the mean duration of medication use was 4.0 ± 4.7 years (Table 1).

Before LSG, 48 patients (79%) were taking antidiabetic medication (oral hypoglycemic agents and/or insulin) and 5

Discussion

The gastric band operation and LSG have gained importance in recent years because of their ability to cause weight loss. LSG causes weight loss by a direct reduction of the stomach volume. This procedure is relatively safe, and the short-term outcomes have been promising [11]. LSG is relatively less time consuming and can be performed using a laparoscope.

In a recent study, Vidal et al. [15] reported on the benefits of LSG in 39 morbidly obese patients with T2DM. Their patients experienced a 63%

Conclusion

Our results have shown that LSG is an effective adjunct in the treatment of T2DM in obese individuals. The possible mechanisms for this need further investigation.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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