Gastrectomy for Diabetes Outperforms Medical Care

Sleeve gastrectomy improves diabetes mellitus (DM) outcomes among patients with type 2 DM better than medical care, according to a new study.

“It is interesting to note that sleeve gastrectomy may offer better diabetes control and improved outcomes compared to patients who follow medical care only. Individuals with obesity now have another treatment option that can help reduce weight and manage diabetes,” said senior author Pietra Greenberg, MD, an endocrinologist at James J. Peters Veterans Affairs Medical Center in Bronx, NY. However, the improvement in outcomes in surgery patients may not be a permanent solution for DM outcomes, she noted.

Laparoscopic sleeve gastrectomy is now a common low-morbidity surgical technique for weight loss. Previous cohort studies have shown improvement in obesity in patients undergoing sleeve gastrectomy. Dr Greenberg and colleagues designed a study to compare long-term DM outcomes in patients who underwent sleeve gastrectomy with controls who received nonsurgical DM care.

The researchers compared the medical records from 2010 to 2014 of 53 veterans with type 2 DM, 30 patients who underwent sleeve gastrectomy and 23 patients who received medical DM care but did not receive any weight loss surgery. Virtually all of the patients, average age 57 years, were men; they had had DM for an average of 10 years. Their median body mass index (BMI) at baseline was 41 kg/m²; their median hemoglobin A1c (HbA1c) level was 7.3%.

Over a 2-year follow-up period, on average, the nonsurgical controls did not lose weight and therefore had no change in average BMI, reported Sheetal Malhotra, MD, MS, internal medicine resident at James J. Peters VA Medical Center. In the sleeve gastrectomy group, BMI decreased from 41 kg/m² (morbidly obese) to 34 kg/m² 2 years after surgery.

HbA1c level also was significantly different between the 2 groups. It fell from an average of 7.25% before sleeve gastrectomy (but after lifestyle changes, such as diet and exercise) to 5.98%. Among the controls, average HbA1C level did not change significantly.

Three-fourths of the patients after sleeve gastrectomy took fewer DM medications, such as insulin, which is common when patients with type 2 DM lose a great deal of weight, Dr Greenberg said. In comparison, only one-fourth of patients in the nonsurgical group reduced their medications, Dr Malhotra reported. No changes were seen in total cholesterol or LDL cholesterol for surgery patients.

“This research highlights the benefits of a surgical approach such as sleeve gastrectomy to help improve diabetes outcomes, especially compared to more conservative medical management,” Dr Greenberg said.

She noted, however, that the improvement in DM measures in the surgical group reached a plateau at the end of 2 years. “Surgery may not be a permanent solution to improving diabetes control,” Dr Greenberg said. “However, the procedure does have immediate benefits that appear to set the patient on a path to a healthier future.”

The researchers presented the results on June 23, 2014 at the 16th International Congress of Endocrinology and the Endocrine Society’s 96th Annual Meeting and Expo in Chicago.