Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of Laparoscopic Sleeve Gastrectomy and Intensive Medical Management in Obese Patients with Type 2 Diabetes Mellitus

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score.

Methods

We evaluated the efficacy of LSG (n = 14) vs. IMT (n = 17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9 ± 5.3kg/m2 and target HbA1c < 7 %. The mean (±SD) age of the patients was 49.6 ± 11.9 years and 74 % were women. The mean duration of diabetes was 8.5 ± 6.1 years and mean HbA1c was 8.6 ± 1.3 %. Primary end point was excess body weight loss (EBWL) at the final follow-up.

Results

The mean duration of follow-up was 12.5 ± 5.0 (median 12) months. EBWL was 61.2 ± 17.6 % and 27.4 ± 23.6 % in LSG and IMT group respectively (p < 0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6 ± 1.5 % in LSG and 7.1 ± 1.2 % in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29 % of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT.

Conclusions

In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Anjana RM, Pradeepa R, Deepa M, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia. 2011;54(12):3022–7.

    Article  PubMed  CAS  Google Scholar 

  2. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(12):1090–101.

    Article  PubMed  CAS  Google Scholar 

  3. Standards of medical care in diabetes. Diabetes Care. 2013; 36 Suppl 1:S11-66.

    Google Scholar 

  4. Dixon JB, Zimmet P, Alberti KG, et al. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med J Br Diabet Assoc. 2011;28(6):628–42.

    Article  CAS  Google Scholar 

  5. Garcia-Caballero M, Valle M, Martinez-Moreno JM, et al. Resolution of diabetes mellitus and metabolic syndrome in normal weight 24–29 BMI patients with one anastomosis gastric bypass. Nutr Hosp Org Of Soc Esp Nutr Parenter Enter. 2012;27(2):623–31.

    CAS  Google Scholar 

  6. Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE comprehensive diabetes management algorithm 2013. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinologist. 2013;19(2):327–36.

    Google Scholar 

  7. Zachariah S, Sheldon B, Shojaee-Moradie F, et al. Insulin detemir reduces weight gain as a result of reduced food intake in patients with type 1 diabetes. Diabetes Care. 2011;34(7):1487–91.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  8. Verges B, Bonnard C, Renard E. Beyond glucose lowering: glucagon-like peptide-1 receptor agonists, body weight and the cardiovascular system. Diabetes Metab. 2011;37(6):477–88.

    Article  PubMed  CAS  Google Scholar 

  9. Scopinaro N, Gianetta E, Adami GF, et al. Biliopancreatic diversion for obesity at eighteen years. Surgery. 1996;119(3):261–8.

    Article  PubMed  CAS  Google Scholar 

  10. Cummings DE, Overduin J, Foster-Schubert KE, et al. Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2007;3(2):109–15.

    Article  Google Scholar 

  11. Moo TA, Rubino F. Gastrointestinal surgery as treatment for type 2 diabetes. Curr Opin Endocrinol Diabetes Obes. 2008;15(2):153–8.

    Article  PubMed  Google Scholar 

  12. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1–27.

    Article  CAS  Google Scholar 

  13. Dixon JB, Straznicky NE, Lambert EA, et al. Surgical approaches to the treatment of obesity. Nat Rev Gastroenterol Hepatol. 2011;8(8):429–37.

    Article  PubMed  Google Scholar 

  14. Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: a systematic review. Obes Surg. 2012;22(5):721–31.

    Article  PubMed  Google Scholar 

  15. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA J Am Med Assoc. 2004;292(14):1724–37.

    Article  CAS  Google Scholar 

  16. Vilsboll T, Christensen M, Junker AE, et al. Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. BMJ. 2012;344:d7771.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  17. Astrup A, Rossner S, Van Gaal L, et al. Effects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet. 2009;374(9701):1606–16.

    Article  PubMed  CAS  Google Scholar 

  18. Dushay J, Gao C, Gopalakrishnan GS, et al. Short-term exenatide treatment leads to significant weight loss in a subset of obese women without diabetes. Diabetes Care. 2012;35(1):4–11.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  19. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  20. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  PubMed  CAS  Google Scholar 

  21. Yong W, Shibo W, Jingang L. Remission of insulin resistance in type 2 diabetic patients after gastric bypass surgery or exenatide therapy. Obes Surg. 2012;22(7):1060–7.

    Article  PubMed  Google Scholar 

  22. Batsis JA, Lopez-Jimenez F, Collazo-Clavell ML, et al. Quality of life after bariatric surgery: a population-based cohort study. Am J Med. 2009;122(11):1055 e1–1055 e10.

    Article  Google Scholar 

  23. Dymek MP, Le Grange D, Neven K, et al. Quality of life after gastric bypass surgery: a cross-sectional study. Obes Res. 2002;10(11):1135–42.

    Article  PubMed  Google Scholar 

  24. Jackness C, Karmally W, Febres G, et al. Very low calorie diet mimics the early beneficial effect of roux-en-y gastric bypass on insulin sensitivity and beta-cell function in type 2 diabetic patients. Diabetes. 2013.

Download references

Acknowledgments

We are grateful to Sun Pharmaceutics, India for providing exenatide (Exapride) for the study.

Conflict of Interest

None.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Gaurav Palikhe, Naresh Sachdeva, Prathosh Gangadhar & Anil Bhansali

  2. Surgical Gastroenterology Division, Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Rajesh Gupta

  3. Department of Dietetics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    B. N. Behera

Authors
  1. Gaurav Palikhe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajesh Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. N. Behera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naresh Sachdeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Prathosh Gangadhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anil Bhansali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anil Bhansali.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Palikhe, G., Gupta, R., Behera, B.N. et al. Efficacy of Laparoscopic Sleeve Gastrectomy and Intensive Medical Management in Obese Patients with Type 2 Diabetes Mellitus. OBES SURG 24, 529–535 (2014). https://doi.org/10.1007/s11695-013-1114-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-013-1114-9

Keywords

Search

Navigation