Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus.

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/m(2) 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.

• Authors: Gaurav Palikhe, Rajesh Gupta, B N Behera, Naresh Sachdeva, Prathosh Gangadhar, Anil Bhansali
• Journal: Obesity surgery (Obes Surg) Vol. 24 Issue 4 Pg. 529-35 (Apr 2014) ISSN: 1708-0428 [Electronic] United States
• PMID: 24272885 (Publication Type: Journal Article)

Chemical References

• Hypoglycemic Agents
• Insulin, Long-Acting
• Peptides
• Venoms
• Insulin Detemir
• Metformin
• Exenatide

Topics

• Adult
• Aged
• Comorbidity
• Diabetes Mellitus, Type 2 (blood, epidemiology)
• Drug Therapy, Combination
• Exenatide
• Female
• Gastrectomy (methods)
• Humans
• Hypertension (epidemiology)
• Hypoglycemic Agents (therapeutic use)
• Insulin Detemir
• Insulin, Long-Acting (therapeutic use)
• Laparoscopy
• Male
• Metformin (therapeutic use)
• Middle Aged
• Peptides (therapeutic use)
• Quality of Life
• Treatment Outcome
• Venoms (therapeutic use)
• Young Adult