- •Bariatric surgery is safe and effective in diabetic patients.
- •Every unit of increased BMI improves the chance of diabetes remission by 16%.
- •Increased levels of HbA1C reduce the chance of diabetes remission by 0.9%.
- •Laparoscopic sleeve gastrectomy improves commodities in diabetic patients.
Background and aim
Obesity is a global concern with several health-related complications. Bariatric surgeries are major treatment options in patients with obesity and other comorbidities. This study aims to investigate the effects of sleeve gastrectomy on metabolic indexes, hyperechogenic liver changes, inflammatory state, diabetes, and other obesity-related comorbidities remission after the sleeve gastrectomy.
This prospective study was conducted on patients with obesity candidates for laparoscopic sleeve gastrectomy. Patients were followed for one year after the surgery. Comorbidities, metabolic and inflammatory parameters were assessed before and one- year after the surgery.
137 patients (16 males, 44 in the DM group) underwent sleeve gastrectomy. One year after the study, obesity-related comorbidities improved significantly; diabetes had complete remission in 22.7% and partial remission in 63.6% of patients. Hyper-cholesterolemia, hyper-triglyceridemia, and hyper-uricemia also improved in 45.6%, 91.2%, and 69% of the patients. Metabolic syndrome indexes improved in 17.5% of the patients. Also, the prevalence of hyperechogenic changes in the liver has declined from 21% before the surgery to 1.5% after that. Based on logistic regression analysis, increased levels of HbA1C reduced the chance of diabetes remission by 0.9%. In comparison, every unit of increased BMI before the surgery improved the case of diabetes remission by 16%.
Laparoscopic sleeve gastrectomy is a safe and effective treatment option in patients with obesity and diabetes. Laparoscopic sleeve gastrectomy alleviates BMI and insulin resistance and effectively improves other obesity-related comorbidities such as Hypercholesterolemia, hyper-triglyceridemia, hyper-uricemia, and hyperechogenic changes of the liver. HbA1C and BMI before the surgery are notable predictors of diabetes remission within the first year after the surgery.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Primary Care Diabetes
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The epidemiology of obesity.Metab.: Clin. Exp. 2019; 92: 6-10
- Adult obesity complications: challenges and clinical impact.Ther. Adv. Endocrinol. Metab. 2020; 11 (2042018820934955)
- Why primary obesity is a disease?.J. Transl. Med. 2019; 17: 169
- Obesity and inflammation: the linking mechanism and the complications.Archives of medical science. 13. AMS,, 2017: 851-863
- Inflammatory mechanisms linking obesity and metabolic disease.J. Clin. Investig. 2017; 127: 1-4
- The role of inflammation in diabetes: current concepts and future perspectives.Eur. Cardiol. 2019; 14: 50-59
- Treatment of obesity: weight loss and bariatric surgery.Circ. Res. 2016; 118: 1844-1855
- Sleeve gastrectomy improves glycemia independent of weight loss by restoring hepatic insulin sensitivity.Diabetes. 2018; 67: 1079-1085
- The physiology and molecular underpinnings of the effects of bariatric surgery on obesity and diabetes.Annu. Rev. Physiol. 2017; 79: 313-334
- Early weight loss independent effects of sleeve gastrectomy on diet-induced cardiac dysfunction in obese, wistar rats.Obes. Surg. 2017; 27: 2370-2377
- Mechanisms responsible for metabolic improvements of bariatric surgeries.Diabetes. 2018; 67: 1043-1044
- The pro-inflammatory marker soluble suppression of tumorigenicity-2 (ST2) is reduced especially in diabetic morbidly obese patients undergoing bariatric surgery.Cardiovasc. Diabetol. 2020; 19: 26
- Effects of bariatric surgery on adipokine-induced inflammation and insulin resistance.Front. Endocrinol. 2013; 4: 69
- Long-term weight loss and metabolic syndrome remission after bariatric surgery: the effect of sex, age, metabolic parameters and surgical technique - a 4-year follow-up study.Obes. Facts. 2019; 12: 639-652
- Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different.J. Endocrinol. Investig. 2019; 42: 117-128
Swarup S., Goyal A., Grigorova Y., Zeltser R. Metabolic Syndrome. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC.; 2021.
- Ultrasound-based techniques for the diagnosis of liver steatosis.World J. Gastroenterol. 2019; 25: 6053-6062
- Cardiovascular disease and risk management.Diabetes Care. 2016; 39: S60-S71
- Use and abuse of HOMA modeling.Diabetes Care. 2004; 27: 1487-1495
- How do we define cure of diabetes?.Diabetes Care. 2009; 32: 2133-2135
- Improvement of renal function after bariatric surgery: a systematic review and meta-analysis.Obes. Surg. 2021; 31: 4470-4484
- Renal function and remission of hypertension after bariatric surgery: a 5-year prospective Cohort study.Obes. Surg. 2017; 27: 613-619
- Anti-inflammatory effects of gastric bypass surgery and their association with improvement in metabolic profile.Expert Rev. Endocrinol. Metab. 2015; 10: 435-446
- Bariatric surgery is protective against renal function decline in severely obese patients in the long-term.Obes. Surg. 2021; 31 (1038-45)
- Uric acid level changes after bariatric surgery in obese subjects with type 2 diabetes mellitus.Ann. Transl. Med. 2019; 7: 332
- Effects of bariatric surgery on serum uric acid in people with obesity with or without hyperuricaemia and gout: a retrospective analysis.Rheumatology. 2021; 60: 3628-3634
- Obesity, hypertension, and bariatric surgery.Curr. Hypertens. Rep. 2020; 22: 46
- Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery.Gland Surg. 2020; 9: 80-93
- Effect of bariatric surgery on hypertension: a meta-analysis.Ann. Pharmacother. 2014; 48: 674-682
- Clinical outcomes among morbidly obese patients hospitalized with diabetic foot complications.Clin. Obes. 2019; 9e12285
- Roux-en-Y gastric bypass versus calorie restriction: support for surgery per se as the direct contributor to altered responses of insulin and incretins to a mixed meal.Surg. Obes. Relat. Dis.: Off. J. Am. Soc. Bariatr. Surg. 2017; 13: 234-242
- Mechanisms of improved glycaemic control after Roux-en-Y gastric bypass.Dan. Med. J. 2015; 62: B5057
- The effect of laparoscopic sleeve gastrectomy (LSG) on glycemic control in morbidly obese patients.Int. J. Surg. (Lond., Engl. ). 2016; 28: 131-135
- Progress in treatment of type 2 diabetes by bariatric surgery.World J. Diabetes. 2021; 12: 1187-1199
- Weight-Independent Mechanisms of Glucose Control After Roux-en-Y Gastric Bypass.Front. Endocrinol. 2018; 9: 530
- Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones.J. Clin. Endocrinol. Metab. 2013; 98: 4391-4399
- Diabetes remission status during seven-year follow-up of the longitudinal assessment of bariatric surgery study.J. Clin. Endocrinol. Metab. 2021; 106: 774-788
- Diabetes remission and relapse after bariatric surgery: a nationwide population-based study.Obes. Surg. 2020; 30: 4810-4820
- Long-term metabolic effects of laparoscopic sleeve gastrectomy.JAMA Surg. 2015; 150: 1051-1057
- Predictors of type-2 diabetes remission following bariatric surgery after a two-year follow-up.Asian J. Surg. 2022; 45: 2645-2650
- Physiologic mechanisms of type II diabetes mellitus remission following bariatric surgery: a meta-analysis and clinical implications.J. Gastrointest. Surg. 2020; 24: 728-741
- Impact of metabolic surgery on gut microbiota and sera metabolomic patterns among patients with diabetes.Int J. Mol. Sci. 2022; 23
- Effects of bariatric surgery on HDL cholesterol.Obes. Surg. 2020; 30: 1793-1798
- Laparoscopic sleeve gastrectomy resolves NAFLD: another formal indication for bariatric surgery?.Obes. Surg. 2018; 28: 4022-4033
- Prediction of type 2 diabetes remission after bariatric or metabolic surgery.J. Obes. Metab. Syndr. 2018; 27: 213-222
- Predictive factors for diabetes remission after bariatric surgery.Can. J. Surg. J. Can. De. Chir. 2019; 62: 315-319
- C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass.Clinics. 2021; 76e2906
- Gender-related metabolic outcomes of laparoscopic sleeve gastrectomy in 6-month follow-up.Wideochirurgia i inne Tech. Maloinwazyjne Video Other Miniinvasive Tech. 2020; 15: 148-156
Published online: March 07, 2023
Accepted: March 5, 2023
Received in revised form: February 21, 2023
Received: August 27, 2022
© 2023 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.