Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus

Abstract 

Background

To prospectively evaluate the efficacy and safety of laparoscopic sleeve gastrectomy (LSG) in Indian subjects with type 2 diabetes mellitus and a body mass index >33 kg/m² in a tertiary care hospital in Pune, India. Morbid obesity associated with type 2 diabetes mellitus has many health implications. A definitive long-term strategy is needed to control obesity and its deleterious effects. LSG is one such approach.

Methods

The patients who underwent LSG were followed up until the end of 1 year after surgery. The change in hemoglobin A1c levels, waist circumference, total body weight, and the use of oral hypoglycemic agents and insulin were studied.

Results

A total of 53 patients (24 men and 29 women, age 46.5 ± 8.7 years, body mass index 45.2 ± 9.3 kg/m², waist circumference 117 ± 18 cm, and hemoglobin A1c 8.4% ± 1.6%) fulfilled the entry criteria and underwent LSG. Before LSG, 48 patients (79%) required antidiabetic medication (oral hypoglycemic agents and insulin) and 5 managed their diabetes with diet control. At 1 month after LSG, 39 (81.2%) of 48 patients no longer required antidiabetic medications and had achieved euglycemia with diet control alone. The use of antidiabetic medications was reduced in 9 (18.8%) of 52 patients. At 1 year, euglycemia was observed in 51 patients (96.2%) without medication and 2 (3.8%) of the 53 patients had reduced their medication dosage.

Conclusion

LSG is an effective adjunct in the treatment of type 2 diabetes mellitus in obese individuals. It appears that improvement in glycemic control is achieved even before weight reduction, and the possible mechanisms explaining this need further investigation.

Keywords: Laparoscopy sleeve gastrectomy, Morbid obesity, Type 2 diabetes mellitus, Antidiabetic drugs