ROME, Italy – Laparoscopic gastric sleeve resection (LGS) significantly improves the symptoms of type 2 diabetes mellitus (T2DM) and its complications compared with conventional pharmacological treatment, according to the results of a study published online in the Archives of Surgery on 2012-4-16.
Dr. Frida Leonetti and colleagues at the PoliclinicoUmbertoI University of Rome, Italy, conducted a study that included 60 patients with morbid obesity combined with T2DM, 30 of whom underwent gastric sleeve resection and 30 of whom underwent conventional pharmacological treatment.
After 18 months, 24 (80%) of the 30 patients in the surgery group had resolution of their diabetes and their BMI had decreased from 41.3 before surgery to 28.3 (p<0.001). In contrast, patients in the conventional treatment group had an increase in BMI from 39 at enrollment to 39.8 (p>0.05) and remained all diabetic.
”We found significant changes in weight loss, BMI and triglyceride reduction, and HDL elevation, with an 80% remission rate of T2DM over 18 months, a finding that demonstrates the effectiveness of LSG in treating this group of patients,” the investigators wrote.
The study was conducted between January and April 10, 2009, at the Morbid Obesity Surgical Treatment Center. Although the investigators offered patients a choice of either surgery or medication, the diabetic patients chose LSG treatment. Other treatment options chosen by the patients were not included in the study.
LSG is a minimally invasive procedure in which the surgeon removes most of the stomach, leaving only a small, banana-shaped gastric storage pouch that fills up quickly when food is eaten. The volume of the remaining stomach in this study was 60 ml.
Conventional treatment consisted of consultation with a medical professional, lifestyle changes, medication, regular exercise and a 1200 calorie meal.
LSG combination conventional treatment group results
Results
Baseline values
18 months
p
LSG group
Blood glucose (mg/dL)
166
97
0.005
Triglycerides (mg/dL)
169
97
0.001
High-density lipoprotein (mg/dL)
48.3
61
0.014
HbA1c (%)
7.9
6
0.018
Conventional treatment group
Blood glucose (mg/dL)
183
150
0.03
Triglycerides (mg/dL)
199
173
>0.05
High-density lipoprotein (mg/dL)
46.6
48
>0.05
HbA1c (%)
8.1
7.1
0.02
In addition, 20 patients with a history of diabetes less than 10 years discontinued glucose-lowering therapy during the follow-up period. “Duration of diabetes is an important prognostic factor for diabetes remission and/or progression,” the investigators said.
Eighty percent of the patients who underwent surgery experienced remission of diabetes symptoms, a reduction in the incidence of obstructive sleep apnea from 50 percent to 10 percent over the course of the study, and a significant reduction in antihypertensive and lipid-regulating medications. The opposite was true for those who did not undergo surgery.
A recent survey cited by Dr. Jon Gould of the Medical College of Wisconsin in Milwaukee found that only 10 percent of morbidly obese adults were treated with surgery by their primary care physicians, according to an invited commentary in an affiliation.
A strong collaboration with primary care physicians is needed to educate the public about the remarkable effectiveness and safety of bariatric surgery,” Gould said. National guidelines for bariatric surgery for T2DM and BMI ≥ 35 also need to be developed. Obese diabetic patients have the right to undergo bariatric surgery under appropriate medical conditions.”