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Type 2 Diabetes Mellitus and the Metabolic Syndrome Following Sleeve Gastrectomy in Severely Obese Subjects

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Abstract

Background

Data on the effectiveness of sleeve gastrectomy in improving or resolving type 2 diabetes mellitus (T2DM) and the metabolic syndrome (MS) are scarce.

Methods

A twelve-month prospective study on the changes in glucose homeostasis and the MS in 91 severely obese T2DM subjects undergoing laparoscopic SG (SG; n = 39) or laparoscopic Roux-en-Y gastric bypass (GBP; n = 52), matched for DM duration, type of DM treatment, and glycemic control was conducted.

Results

At 12 months after surgery, subjects undergoing SG and GBP lost a similar amount of weight (%EBL: SG: 63.00 ± 2.89%, BPG: 66.06 ± 2.34%; p = 0.413). On that evaluation, T2DM had resolved, respectively, in 33 out of 39 (84.6%) and 44 out of 52 (84.6%) subjects after SG and GBP (p = 0.618). The rate of resolution of the MS (SG: 62.2%, BPG: 67.3%; p = 0.392) was also comparable. A shorter DM duration (p < 0.05), a DM treatment not including pharmacological agents (p < 0.05), and a better glycemic control (p < 0.05), were significantly associated with T2DM resolution in both surgical groups. Weight loss was not associated with T2DM resolution after SG or GBP, but was associated with resolution of the MS following the two surgical procedures (p < 0.05).

Conclusions

Our data show that at 12 months after surgery, SG is as effective as GBP in inducing remission of T2DM and the MS. Furthermore, our data suggest that SG and GBP represent a successful an integrated strategy for the management of the different cardiovascular risk components of the MS in subjects with T2DM.

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References

  1. Buchwald H, Avidor Y, Brawnwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  PubMed  CAS  Google Scholar 

  2. Kral JG, Näslund E. Surgical treatment of obesity. Nat Clin Pract Endocrinol Metab. 2007;3:574–83.

    Article  PubMed  Google Scholar 

  3. Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2004;89:2608–15.

    Article  PubMed  CAS  Google Scholar 

  4. Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, 25–27 October 2007. Obes Surg. 2008;18:487–96.

    Article  PubMed  Google Scholar 

  5. Regan JP, INabnet WB, Gagner M, Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.

    Article  PubMed  CAS  Google Scholar 

  6. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.

    Article  PubMed  Google Scholar 

  7. Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc. 2007;21:1810–6.

    Article  PubMed  Google Scholar 

  8. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.

    Article  PubMed  Google Scholar 

  9. Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.

    Article  PubMed  CAS  Google Scholar 

  10. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.

    Article  PubMed  CAS  Google Scholar 

  11. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.

    Article  PubMed  Google Scholar 

  12. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16:1138–44.

    Article  PubMed  Google Scholar 

  13. Vidal J, Ibarzabal A, Nicolau J, et al. Short-term effects of sleeve gastrectomy on type 2 diabetes mellitus in severely obese subjects. Obes Surg. 2007;17:1069–74.

    Article  PubMed  CAS  Google Scholar 

  14. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.

    PubMed  Google Scholar 

  15. Torquati A, Lutfi R, Abumrad N, et al. Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients? J Gastrointest Surg. 2005;9:1112–8.

    Article  PubMed  Google Scholar 

  16. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diab Care. 2003;26:S5–20.

    Google Scholar 

  17. Grundy SM, Cleeman JI, Daniels SR, et al. American heart association; national heart, lung, and blood institute. Diagnosis and management of the metabolic syndrome: an american heart association/national heart, lung, and blood institute scientific statement. Circulation. 2005;25:2735–52.

    Article  Google Scholar 

  18. Vidal J, Morinigo R, Codoceo VH, et al. The importance of diagnostic criteria in the association between the metabolic syndrome and cardiovascular disease in obese subjects. Int J Obes Relat Metab Disord. 2005;29:668–74.

    Article  CAS  Google Scholar 

  19. Morínigo R, Casamitjana R, Moizé V, et al. Short-term effects of gastric bypass surgery on circulating ghrelin levels. Obes Res. 2004;12:1108–16.

    Article  PubMed  Google Scholar 

  20. Gan SS, Talbot ML, Jorgensen JO. Efficacy of surgery in the management of obesity-related type 2 diabetes mellitus. ANZ J Surg. 2007;77:958–62.

    Article  PubMed  Google Scholar 

  21. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23.

    Article  PubMed  CAS  Google Scholar 

  22. le Roux CW, Aylwin SJ, Batterham RL, Borg CM, Coyle F, Prasad V, et al. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg. 2006;243:108–14.

    Article  PubMed  Google Scholar 

  23. Rodieux F, Giusti V, D’Alessio DA, Suter M, Tappy L. Effects of gastric bypass and gastric banding on glucose kinetics and gut hormone release. Obesity. 2008;16:298–305.

    Article  PubMed  CAS  Google Scholar 

  24. Dixon JB, Pories WJ, O’Brien PE, Schauer PR, Zimmet P. Surgery as an effective early intervention for diabesity: why the reluctance? Diabetes Care. 2005;28:472–4.

    Article  PubMed  Google Scholar 

  25. Cull CA, Jensen CC, Retnakaran R, Holman RR. Impact of the metabolic syndrome on macrovascular and microvascular outcomes in type 2 diabetes mellitus: United Kingdom Prospective Diabetes Study 78. Circulation. 2007;116:2119–26.

    Article  PubMed  Google Scholar 

  26. Lee WJ, Huang MT, Wang W, Lin CM, Chen TC, Lai IR. Effects of obesity surgery on the metabolic syndrome. Arch Surg. 2004;139:1088–92.

    Article  PubMed  Google Scholar 

  27. Mattar SG, Velcu LM, Rabinovitz M, Demetris AJ, Krasinskas AM, Barinas-Mitchell E, et al. Surgically-induced weight loss significantly improves nonalcoholic fatty liver disease and the metabolic syndrome. Ann Surg. 2005;242:610–7.

    PubMed  Google Scholar 

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Acknowledgment

This work was supported by grants from the Fondo de Investigaciones Sanitarias of the Instituto de Salud Carlos III (PI060157 and REDIMET RD06/0015) Madrid, Spain.

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Authors and Affiliations

  1. Obesity Unit, Hospital Clinic Universitari, Villarroel 170, 08036, Barcelona, Spain

    J. Vidal, A. Ibarzabal, F. Romero, S. Delgado, D. Momblán, L. Flores & A. Lacy

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  1. J. Vidal
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  2. A. Ibarzabal
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  3. F. Romero
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  4. S. Delgado
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  5. D. Momblán
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  6. L. Flores
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  7. A. Lacy
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Correspondence to J. Vidal.

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Vidal, J., Ibarzabal, A., Romero, F. et al. Type 2 Diabetes Mellitus and the Metabolic Syndrome Following Sleeve Gastrectomy in Severely Obese Subjects. OBES SURG 18, 1077–1082 (2008). https://doi.org/10.1007/s11695-008-9547-2

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  • DOI: https://doi.org/10.1007/s11695-008-9547-2

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