Elsevier

Surgery for Obesity and Related Diseases

Volume 6, Issue 6, November–December 2010, Pages 707-713
Surgery for Obesity and Related Diseases

Review article
Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review

https://doi.org/10.1016/j.soard.2010.07.011Get rights and content

Abstract

Background

Existing evidence has suggested that bariatric surgery produces sustainable weight loss and remission or cure of type 2 diabetes mellitus (DM). Laparoscopic sleeve gastrectomy (LSG) has garnered considerable interest as a low morbidity bariatric surgical procedure that leads to effective weight loss and control of co-morbid disease. The objective of the present study was to systematically review the effect of LSG on type 2 DM.

Methods

An electronic data search of MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database was completed. The search terms used included LSG, vertical gastrectomy, bariatric surgery, metabolic surgery, and diabetes (DM), type 2 DM, or co-morbidities. All human studies, not limited to those in the English language, that had been reported from 2000 to April 2010 were included.

Results

After an initial screen of 3621 titles, 289 abstracts were reviewed, and 28 studies met the inclusion criteria and the full report was assessed. One study was excluded after a careful assessment because the investigators had combined LSG with ileal interposition. A total of 27 studies and 673 patients were analyzed. The baseline mean body mass index for the 673 patients was 47.4 kg/m2 (range 31.0–53.5). The mean percentage of excess weight loss was 47.3% (range 6.3–74.6%), with a mean follow-up of 13.1 months (range 3–36). DM had resolved in 66.2% of the patients, improved in 26.9%, and remained stable in 13.1%. The mean decrease in blood glucose and hemoglobin A1c after sleeve gastrectomy was −88.2 mg/dL and −1.7%, respectively.

Conclusion

Most patients with type 2 DM experienced resolution or improvement in DM markers after LSG. LSG might play an important role as a metabolic therapy for patients with type 2 DM.

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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