Sleeve gastrectomy reduces diabetes, CV risk factors

Sleeve gastrectomy reduces diabetes, CV risk factors

Rome, Italy – Laparoscopic sleeve gastrectomy (LSG) has proved highly effective in alleviating type 2 diabetes (T2DM) and its complications, compared with traditional medical treatment, according to a study published online April 16, 2012 in theArchives of Surgery [1].

Dr Frida Leonetti (Policlinico Umberto I University of Rome Sapienza, Italy) and colleagues conducted a study involving 60 morbidly obese patients with type 2 diabetes, 30 of whom underwent sleeve gastrectomy and 30 of whom were treated with conventional medical therapy.

Of the 30 patients in the surgical group, 24, or 80%, had their diabetes resolved by 18 months after surgery and reduced their mean body-mass index (BMI) from 41.3 preoperatively to 28.3 after 18 months (p<0.001). Conversely, patients in the traditional treatment group increased their mean BMI from 39 upon entering the study to 39.8 after 18 months (p>0.05), and all remained diabetic.

“We found significant differences regarding excess weight loss, the decreases in BMI and triglycerides, and the increase of high-density lipoprotein [HDL] cholesterol,” the researchers write. “With a T2DM remission rate of 80% at 18 months, the results of the present study confirm the efficacy of LSG in the treatment of these patients.”

The study took place at the Center for the Surgical-Medical Treatment of Morbid Obesity between January 2009 and April 10. The researchers offered patients eligible for bariatric surgery choices of surgery types or medical treatment, although diabetic patients did receive advice to undergo LSG. Patients electing other procedures were not part of the study.

LSG is a minimally invasive procedure during which a surgeon removes a major portion of the stomach and leaves a small banana-shaped pouch that fills up quickly when a person eats. A 60-mL gastric pouch was left for patients in this study.

Conventional therapy included medical staff consultations, recommended lifestyle modifications, drug therapy, regular physical activity, and a 1200-calorie diet.

Outcomes of patients undergoing LSG vs patients treated with intensive medical therapy 

Outcome B aseline 18 mo  p
LSG group
166 97 0.005
169 97 0.001
48.3 61 0.014
1c 7.9 6 0.018
Medical- treatment group
183 150 0.03
199 173 >0.05
46.6 48 >0.05
1c 8.1 7.1 0.02

In addition, 20 surgery patients who had had diabetes for less than 10 years stopped taking antidiabetic therapy during the follow-up period. “Diabetes duration is an important prognostic factor for diabetes remission and/or improvement,” the researchers write.

For the 80% of surgery patients whose diabetes went into remission, obstructive sleep apnea prevalence dropped from 50% to 10% during the study period, and they significantly reduced their use of hypertension and dyslipidemia medications. The nonsurgical group experienced the opposite effect.

In an accompanying invited critique, Dr Jon C Gould (Medical College of Wisconsin, Milwaukee) cited a recent survey that found that only 10% of morbidly obese adults have had bariatric surgery recommended for them by their primary-care physicians [2].

“There is a great opportunity to partner with primary-care physicians and to educate the public on the significant benefits and safety of bariatric surgery. National guidelines for bariatric surgery need to be developed for people with type 2 diabetes and a body-mass index of 35 or more,” Gould writes. “An obese diabetic patient should have access to bariatric surgery in appropriate clinical circumstances.”

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