The rapid effects of sleeve gastrectomy on glucose homeostasis and resolution of diabetes mellitus

Abstract

Abstract Aims Type 2 diabetes caused by obesity is increasing globally. Bariatric surgical procedures are known to have positive effects on glucose homeostasis through neurohormonal action mechanisms. In the present study, we aimed to investigate the factors influencing glucose homeostasis independent of weight loss after the laparoscopic sleeve gastrectomy (LSG). Methods Patients who underwent LSG for morbid obesity in a 3‐year period were evaluated. Data on demographics, clinical characteristics (duration of diabetes, resected gastric volume, antral resection margin) and laboratory parameters (preoperative and postoperative blood glucose on fasting, preoperative HbA1c levels and first‐year HbA1c levels) were retrospectively reviewed. Effect of patients' body mass index (<50 kg/m2, ≥50 kg/m2), first‐year excess weight loss (EWL%) rates, age (≥50 years, <50 years), duration of diabetes (≥5 years, <5 years) and antral resection margin (≥3 cm, <3 cm) on postoperative blood glucose profile and diabetic resolution status were investigated. Results Total of 61 patients constituted the study group. There were 40 female and 21 male patients with an average age of 43.8 ± 10.5 years (19‐67 years). Preoperatively, mean BMI, blood glucose levels and HbA1c were 48.8 ± 8.5 kg/m2, 133.6 ± 47.4 mg/dL and 7.4 ± 1.1, respectively. The mean blood glucose level at the postoperatively 5th day was 88.0 ± 16.3 mg/dL (median: 84 mg/dL) (P < .001). Fifty‐nine out of 61 patients improved their glycaemic control. Conclusions It is noteworthy that LSG can control blood glucose levels in short term after surgery regardless of weight loss. Therefore, LSG should be preferred at earlier stages in the treatment of obesity‐related T2DM in order to prevent T2DM‐related complications.

Keywords

• diabetes mellitus
• laparoscopic sleeve gastrectomy
• obesity
• resolution of diabetes