Abstract
Bariatric surgery proved effective in the treatment of morbid obesity and its associated comorbidities. The aim of this study was to assess weight loss and changes in glucose homeostasis and satiety hormones and to evaluate improvement in diabetic status in morbidly obese patients with type two diabetes mellitus (T2DM) at 6 and 12 months after laparoscopic greater curvature plication (LGCP). Twenty patients with morbid obesity with T2DM were operated upon with LGCP. Weight loss was assessed by the decrease in BMI and percentage of excess weight loss at 6 and 12 months after LGCP. Fasting and postprandial blood glucose levels, HbA1c, fasting serum insulin, serum ghrelin and glucagon-like peptide 1 (GLP-1) levels were measured before and at 6 and 12 months postoperatively. The mean age of patients was 37.6 years. There was significant decrease in BMI from 45.4 to 40.1 at 6 months (p= 0.0008) and then to 36.4 at 12 month (p< 0.0001). The mean fasting blood glucose decreased significantly from 134.8 preoperatively to 120.8 at 6 months (p< 0.0001) and then to 109.5 at 12 months (p< 0.0001). The mean preoperative HbA1c declined from 6.8 before LGCO to 6.3 at 6 months (p< 0.0001) then to 5.9 at 12 months (p< 0.0001). The mean fasting insulin level decreased from 20.5 preoperatively to 17.4 at 6 months (p< 0.0001) then to 16.7 at 12 months (p< 0.0001). The mean baseline ghrelin level decreased significantly from 551.7 preoperatively to 441.5 at 6 months (p< 0.0001) then to 422.5 at 12 months (p< 0.0001). The mean GLP-1 declined from 33.7 before surgery to 33.5 at 6 months (p= 0.76) then to 33.1 at 12 months (p= 0.36). LGCP is an effective bariatric procedure that achieved satisfactory weight loss and significant improvement in the glycemic control as demonstrated by improvement in laboratory markers as serum glucose, insulin, and ghrelin hormone levels.
Highlights
Obesity is a major worldwide health problem, since 1997 the World Health Organization has recognized it as a global epidemic and in 2005 more than 400 million obese adults were recorded [1]
Obesity plays a vital role in the pathogenesis of insulin resistance and type 2 diabetes mellitus (T2DM)
We excluded elderly patients aging more than 60 years, patients with secondary obesity due to endocrine disorders, patient unfit for general anesthesia, patients who had not attempted non-surgical weight loss treatment in the past, patients with psychological conditions that influence his/her perception of the study protocol, and patients with previous surgery for morbid obesity
Summary
Obesity is a major worldwide health problem, since 1997 the World Health Organization has recognized it as a global epidemic and in 2005 more than 400 million obese adults were recorded [1]. While conservative measures as dieting and physical exercise have proven to be inadequate, bariatric surgery proved to be an effective alternative and has become very popular in the last decade [2]. Obesity plays a vital role in the pathogenesis of insulin resistance and type 2 diabetes mellitus (T2DM). Obese patients are at higher risk of T2DM, hypertension, hyperlipidemia, and cardiovascular disease. Bariatric surgery is currently the most effective treatment for weight loss and is shown to lead to rapid and prolonged improvement in insulin resistance and hyperglycemia in the majority of Waleed Omar et al.: Evaluation of Weight Reduction, Diabetic State and Satiety Hormones After Laparoscopic Greater
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