Efficacy of Laparoscopic Sleeve Gastrectomy and Intensive Medical Management in Obese Patients with Type 2 Diabetes Mellitus

Abstract

There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score. We evaluated the efficacy of LSG (n = 14) vs. IMT (n = 17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9 ± 5.3kg/m(2) and target HbA1c < 7%. The mean (±SD) age of the patients was 49.6 ± 11.9years and 74% were women. The mean duration of diabetes was 8.5 ± 6.1years and mean HbA1c was 8.6 ± 1.3%. Primary end point was excess body weight loss (EBWL) at the final follow-up. The mean duration of follow-up was 12.5 ± 5.0 (median 12) months. EBWL was 61.2 ± 17.6% and 27.4 ± 23.6% in LSG and IMT group respectively (p < 0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6 ± 1.5% in LSG and 7.1 ± 1.2% in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29% of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT. In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.