Obese Patients with Type 2 Diabetes: Outcomes After Laparoscopic Sleeve Gastrectomy

Area of Science:

• Metabolic Surgery
• Endocrinology
• Bariatric Procedures

Background:

• Bariatric surgery is recognized for superior type 2 diabetes mellitus (T2DM) control in obese individuals compared to medical management.
• Existing literature predominantly features Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding.
• Laparoscopic sleeve gastrectomy (LSG) is an increasingly common bariatric procedure, necessitating evaluation of its long-term metabolic efficacy for T2DM.

Purpose of the Study:

• To assess the mid- and long-term metabolic outcomes of laparoscopic sleeve gastrectomy (LSG) in obese patients with type 2 diabetes mellitus (T2DM).
• To identify predictors of T2DM remission and recurrence following LSG.

Main Methods:

• A retrospective analysis of 166 obese patients with T2DM who underwent LSG between January 2009 and July 2016.
• Patients were required to have at least one year of follow-up post-surgery.
• T2DM remission was defined as post-operative fasting glucose <100 mg/dL and HbA1c <6% without medication.

Main Results:

• Complete T2DM remission was observed in 78.3% at 1 year, 76.2% at 3 years, and 71.4% at ≥5 years post-LSG.
• Long-term follow-up revealed partial remission in 7.2%, improvement in 10%, and recurrence in 11.4% of patients.
• Preoperative insulin therapy and a T2DM diagnosis duration of ≥5 years were significant predictors of lower remission rates (P=.0004 and P=.0001, respectively).

Conclusions:

• Laparoscopic sleeve gastrectomy (LSG) demonstrates satisfactory mid- and long-term T2DM control in obese patients.
• Predictors for less favorable outcomes include preoperative insulin dependence and a diabetes duration of five years or more.
• LSG is a viable option for T2DM management, but patient selection should consider disease duration and treatment intensity.