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LSG and T2DM

LSG effective, but not permanent T2DM solution

Changes in outcomes plateau after the first year of surgery

Laparoscopic sleeve gastrectomy (LSG) may offer better diabetes control and improved outcomes compared to patients who follow medical care only but the T2DM improvements for surgical patients may not be a permanent solution, according to a comparative study (‘Clinical outcomes of sleeve gastrectomy in veterans with type 2 diabetes’, abstract No. 277) presented at the American Association of Clinical Endocrinologists’ annual meeting in Las Vegas.

Investigators from the University of Nebraska Medical Center compared long term diabetes outcomes in patients undergoing LSG as compared to controls who undergo nonsurgical diabetes care. They reviewed the records of veterans between 18 and 80 years of age with T2DM undergoing LSG at a VA medical centre.

Primary study outcomes included measures of diabetes control including HbA1C and BMI and secondary outcomes included total and LDL cholesterol, hospitalisations and mortality. Data from surgery patients were compared to data from diabetic controls that did not undergo surgery using descriptive analyses, t-tests, and repeated measures ANOVA.

A total of 30 surgery patients and 23 controls were analysed from 2010 to 2013, 96% were male with an average age of 57 years (range 29-80 years). The median BMI at baseline was 41 (range 36-60) and median Hba1c was 7.3.

Post-surgery, there were significant improvement in BMI and Hba1c in after one year follow up; improvements were sustained through the end of two years after surgery. Mean BMI decreased from 41 to 34 over two years (p<0.001) and mean Hba1c decreased from 7.25 to 5.98 (p<0.001). Similar outcomes were not seen in controls during the study period. Differences in these outcomes between surgery patients and controls were significant over short term and long term follow up (p<0.001).

No changes were seen in total cholesterol or LDL cholesterol for surgery patients. However, it was noted that the changes in outcomes plateau after the first year of surgery.

“It is interesting to note that LSG may offer better diabetes control and improved outcomes compared to patients who follow medical care only,” said the researchers. “However, the improvement in outcomes in surgery patients may not be a permanent solution for diabetes outcomes.”

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