Amelioration of Diabetes Mellitus Type II after Sleeve Gastrectomy—Data on Nationwide Survey on Quality Assurance in Bariatric Surgery in Germany

I. El-Sayes, R. Weiner, M. Talai Rad, S. Wolff, C. Knoll, T. Manger, C. Stroh

Department of General, Abdominal and Paediatric Surgery, SRH Hospital, Gera, Germany.
Department of General, Abdominal and Vascular Surgery, University Hospital Magdeburg, Magdeburg, Germany.
Helios Hospital, Bad Saarow, Germany.
Sachsenhausen Hospital, Frankfurt, Germany.
Stat Consult, Magdeburg, Germany.

DOI: 10.4236/ss.2013.412A002                

Abstract

Introduction: Sleeve Gastrectomy (SG) is becoming more popular due to its weight reducing effect and promising anti-diabetic efficacy. However, long term results are still lacking. Methods: The study focuses on anti-diabetic efficacy of SG through retrospective analysis of data for patients who underwent SG in Germany from 2005 to 2011. Anti-diabetic efficacy was assessed at 1, 2 and up to 4 years after surgery. Results: 5400 morbidly obese patients underwent SG. Of these 5400 patients 13.2% (n = 712) were insulin treated (IT) and 21.6% (n = 1165) were non-insulin treated (NIT). Total follow-up was accomplished in 41.24% of patients. Percentage of remission and improvement (RI) at 1 year was 83.8% (80.2% for insulin treated (IT) vs. 85.1% for non-insulin treated (NIT)). RI% at 2 years dropped to 77.6% (76.9% for IT vs. 77.9% for NIT patients). With late follow up (up to 4 years), RI% was 65.9% (58.8% for IT vs. 66.7% for NIT patients). Difference between IT and NIT patients was insignificant. Conclusion: SG shows promising ant-diabetic efficacy at 1 year, 2 years and up to 4 years after surgery. This efficacy gradually drops with prolonged time interval after surgery and seems to be insignificantly higher among NIT vs. IT patients.

Keywords

Sleeve Gastrectomy; Diabetes Mellitus Type II; Diabetes Remission; Metabolic Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. Almogy, P. F. Crookes and G. J. Anthone, “Longitudinal Gastrectomy as a Treatment for the High-Risk Super-Obese Patient,” Obesity Surgery, Vol. 14, No. 4, 2004, pp. 492-497. http://dx.doi.org/ 10.1381/096089204323013479
[2]	M. Deitel, R. D. Crosby and M. Gagner, “The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25-27, 2007,” Obesity Surgery, Vol. 18, No. 5, 2008, pp. 487-496. http://dx.doi.org/10.1007/s11695-008-9471-5
[3]	M. Gagner, M. Deitel, T. L. Kalberer, et al., “The Second International Consensus Summit for Sleeve Gastrectomy, March 19-21, 2009,” Surgery for Obesity and Related Diseases, Vol. 5, No. 4, 2009, pp. 476-485.
[4]	M. Daskalakis and R. A. Weiner, “Sleeve Gastrectomy as a Single-Stage Bariatric Operation: Indications and Limitations,” Obesity Facts, Vol. 2, No. S1, 2009, pp. 8-10. http://dx.doi.org/10.1159/ 000198239
[5]	C. Stroh, R. Weiner, T. Horbach, K. Adipositas, A. Adipositaschirurgie, et al., “New Data on Quality Assurance in Bariatric Surgery in Germany,” Zentralblatta fur Chirurgie, Vol. 138, No. 2, 2013, pp. 180-188.
[6]	“NIH Conference Gastrointestinal Surgery for Severe Obesity. Consensus Development Conference Panel,” Annals of Internal Medicine, Vol. 115, 1991, pp. 956-961.
[7]	American Diabetes Association, “ADA Standards of Medical Care in Diabetes—2009,” Diabetes Care, Vol. 32, No. S1, 2009, pp. S13-S61.
[8]	J. B. Buse, S. Caprio, W. T. Cefalu, et al., “How Do We Define Cure of Diabetes?” Diabetes Care, Vol. 32, No. 11, 2009, pp. 2133-2135.
[9]	F. X. Pi-Sunyer, “The Effects of Pharmacologic Agents for T2DM on Body Weight,” Postgraduate Medicine, Vol. 120, 2008, pp. 5-17. http://dx.doi.org/10.3810/pgm.2008.07.1785
[10]	B. R. Smith, P. Schauer and N. T. Nguyen, “Surgical Approaches to the Treatment of Obesity: Bariatric Surgery,” Endocrinology and Metabolism Clinics of North America, Vol. 37, No. 4, 2008, pp. 943-964. http://dx.doi.org/10.1016/j.ecl.2008.08.001
[11]	J. S. Todkar, S. S. Shah, P. S. Shah and J. Gangwani, “Long-Term Effects of Laparoscopic Sleeve Gastrectomy in Morbidly Obese Subjects with Type 2 Diabetes Mellitus,” Surgery for Obesity and Related Diseases, Vol. 6, No. 2, 2010, pp. 142-145. http://dx.doi.org/10.1016/j.soard.2009.06.008
[12]	M. Dietel, M. Ganger, A. L. Erickson and R. D. Crosby, “Third International Summit: Current Status of Sleeve Gastrectomy,” Surgery for Obesity and Related Diseases, Vol. 7, No. 6, 2012, pp. 749-759.
[13]	I. Braghetto, C. Davanzo, O. Korn, et al., “Scintigraphic Evaluation of Gastric Emptying in Obese Patients Submitted to Sleeve Gastrectomy Compared to Normal Subjects,” Obesity Surgery, Vol. 19, No. 11, 2009, pp. 1515-1521.
[14]	F. Abbatini, D. Capoccia, G. Casella, F. Coccia, F. Leonetti and N. Basso, “Type 2 Diabetes in Obese Patients with Body Mass Index of 30-35 kg/m2: Sleeve Gastrectomy versus Medical Treatment,” Surgery for Obesity and Related Diseases, Vol. 8, No. 1, 2012, pp. 20-24.
[15]	J. Vidal, A. Ibarzabal, J. Nicolau, et al., “Short-Term Effects of Sleeve Gastrectomy on Type 2 Diabetes Mellitus in Severely Obese Subjects,” Obesity Surgery, Vol. 17, No. 8, 2007, pp. 1069-1074.
[16]	F. Rubino and M. Gagner, “Potential of Surgery for Curing Type 2 Diabetes Mellitus,” Annals of Surgery, Vol. 236, No. 5, 2002, pp. 554-559. http://dx.doi.org/10.1097/00000658-200211000-00003
[17]	M. Rizzello, F. Abbatini, G. Casella, et al., “Early Postoperative Insulin-Resistance Changes after Sleeve Gastrectomy,” Obesity Surgery, Vol. 20, No. 1, 2010, pp. 50-55. http://dx.doi.org/10.1007/ s11695-009-0017-2
[18]	J. Ruiz-Tovar, I. Oller, A. Tomas, et al., “Midterm Impact of Sleeve Gastrectomy, Calibrated with a 50-Fr Bougie, on Weight Loss, Glucose Homeostasis, Lipid Profiles, and Comorbidities in Morbidly Obese Patients,” The American Surgeon, Vol. 78, No. 9, 2012, pp. 969-974.
[19]	F. Abbatini, D. Capoccia, G. Casella, E. Soricelli, F. Leonetti and N. Basso, “Long-Term Remission of Type 2 Diabetes in Morbidly Obese Patients after Sleeve Gastrectomy,” Surgery for Obesity and Related Diseases, Vol. 9, No. 4, 2013, pp. 498-502.
[20]	M. Deitel, “Update: Why Diabetes Does Not Resolve in Some Patients after Bariatric Surgery,” Obesity Surgery, Vol. 21, No. 6, 2011, pp. 794-796.
[21]	P. R. Schauer, B. Burguera, S. Ikramuddin, et al., “Effect of Laparoscopic Roux-En y Gastric Bypass on Type 2 Diabetes Mellitus,” Annals of Surgery, Vol. 238, No. 4, 2003, pp. 467-485.