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17-04-2012 | Surgery | Article

Laparoscopic sleeve gastrectomy treats diabetes in morbidly obese patients


Free abstract

MedWire News: Laparoscopic sleeve gastrectomy successfully improves diabetes in morbidly obese patients, say researchers who found significant benefits for surgery compared with conventional medical treatment.

"The association between obesity and diabetes is well established because 90% of patients with type 2 diabetes mellitus (T2DM) show excess body weight…,"write Frida Leonetti (University of Rome, Italy) and colleagues in the Archives of Surgery.

"Because weight loss has an effect on improving T2DM and other comorbid conditions, weight loss must become part of the treatment plan whenever possible."

A total of 60 morbidly obese patients with T2DM were included in the study, 30 underwent sleeve gastrectomy and 30 received conventional therapy. The conventional therapy program consisted of pharmaceutical treatment, a recommended 1200 kcal/day diet, and at least 200 minutes of moderate-intensity aerobic exercise per week.

The researchers found significant differences between the two patient groups regarding decreases in weight, body mass index (BMI), and triglycerides, and the increase of high-density lipoprotein cholesterol. However, decreases in fasting plasma glucose and glycated hemoglobin (HbA1c) levels were only significantly different between the two groups in patients with a T2DM duration of more than 10 years.

In the gastrectomy group, BMI decreased by a mean of 13 kg/m2 during the 18-month study. Their plasma glucose levels decreased by a mean of 70.4 mg/mL, and their HbA1c level decreased from a mean of 7.9% to 6.0%.

On the other hand, on average, among the conventional therapy patients, BMI increased by 0.9 kg/m2, plasma glucose levels decreased by 33.7 mg/mL, and their HbA1c level decreased from 8.1% to 7.1%.

Diabetes was resolved during the study in 80% of the gastrectomy patients; all the conventional therapy patients remained diabetic, and continued or increased their level of hypoglycemic therapy.

The researchers also analyzed the other comorbidities experienced by both groups. Over the course of the study, the prevalence of obstructive sleep apnea syndrome decreased from 50% to 10% in the gastrectomy group, and these patients significantly reduced their use of hypertension and dyslipidemia medication. However, the prevalence of sleep apnea did not change, in the conventional therapy group, and the researchers observed an increase in the use of hypertension and dyslipidemia medications.

In an invited critique of the study, Jon Gould, of the Medical College of Wisconsin in Milwaukee, USA, describes the work by Leonetti and team as "a nice contribution," adding that "by now, this kind of outcome should not come as a surprise to any bariatric surgeon."

He writes: "These findings demonstrate to the bariatric community that 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… An obese diabetic patient should have access to bariatric surgery in appropriate clinical circumstances."

By Chloe McIvor

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