Review articleSleeve gastrectomy and type 2 diabetes mellitus: a systematic review
Section snippets
Description of obesity
Worldwide, >1.7 billion adults are considered overweight, with ≥300 million considered clinically obese [1]. Obesity is generally defined as a body mass index (BMI) >30 kg/m2. Co-morbid diseases related to obesity include hypertension, sleep apnea syndrome, and type 2 diabetes mellitus (DM). It has been proposed that in obese patients, a failure might occur of β-cells to secrete adequate levels of insulin to compensate for the insulin resistance in peripheral tissues, which ultimately leads to
Description of intervention
During the past decade, bariatric surgical procedures such as Roux-en-Y gastric bypass and biliopancreatic diversion have demonstrated long-term control of obesity and type 2 DM [3], [4]. In a recent systematic review, Buchwald et al. [5] demonstrated that 76% of people had resolution of type 2 DM after bariatric surgery. The bariatric surgical procedures included in their review were gastric banding, gastric bypass, gastroplasty, and biliopancreatic diversion with duodenal switch (BPDDS) [5].
How the intervention might work
LSG-associated weight loss is believed to be secondary to restriction of food intake by the small gastric reservoir. However, the mechanism behind LSG and the resolution of type 2 DM has not been clearly defined. Currently, both hormonal changes and a hindgut theory have been postulated to be involved. Karamanakos et al. [8] found a marked reduction of fasting ghrelin levels after LSG surgery. Ghrelin is a hormone produced primarily by the gastric fundus, which inhibits insulin secretion and
Objectives of present review
The primary goal of bariatric surgery is to produce long-term, sustainable weight loss, with improvement of co-morbid disease such as type 2 DM. Despite the efficacy of both gastric bypass and BPDDS, these remain complex surgical procedures with significant postoperative morbidity. LSG is a technically less-complex surgical procedure that has been reported to improve weight loss and type 2 DM remission rates. However, existing studies have consisted of small heterogeneous patient populations.
Methods
The criteria for considering studies for the present review included the study type, participants, interventions, and outcome measures used.
The types of studies we considered included human retrospective and prospective case series (both with >5 patients), nonrandomized controlled trials, and randomized controlled trials.
We considered studies with a target population of adult (>18 years old) male or female patients with type 2 DM who had undergone LSG. Patients considered clinically obese with
Search results
A total of 3621 studies were identified using our search criteria for screening (Fig. 1). After an assessment according to our exclusion criteria, 3332 were rejected and 289 studies remained for abstract review. Of the 289 studies, 28 were identified; 1 was excluded because they had combined LSG with ileal interposition [17]. Thus, a total of 27 primary studies meeting the inclusion criteria were identified after a careful screening. These included 3 nonrandomized prospective controlled trials
Discussion
A systematic review of the existing evidence has suggested that LSG for morbid obesity results in resolution or improvement of type 2DM in most patients. Although approximately two thirds of the patients experienced complete DM resolution, the remaining 30% of patients had significant improvement.
A systematic review by Buchwald et al. [5] demonstrated similar improvement in type 2 DM resolution after other bariatric surgical procedures. Gastric banding, gastric bypass, and BPDDS resulted in
Conclusion
Our findings have shown that LSG has a substantial effect on type 2 DM, producing resolution or improvement in most cases. With the potential to be revised to a gastric bypass or BPDDS procedure, LSG is a promising surgical procedure for the treatment of morbid obesity and type 2 DM.
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
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