Surgical treatment for morbid obesity in patients with type 2 diabetes mellitus

Abstract

Shortly after its implementation, laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric surgery. It is widely believed that DM2 and the associated chronic hyperglycemia (expressed by glycated hemoglobin – HbA<sub>1c</sub>) increase the risk of postoperative complications and mortality, what has been confirmed in some branches of surgery. Hence research on its effect on postoperative outcomes after LSG is extremely valuable. There is a lack of studies analyzing the influence of LSG on prediabetes and DM2 at various time intervals after surgery, especially in the perioperative period, what is important from the perspective of patient care. A retrospective, multicenter observational study of LSG patients and a prospective observational study in DM2 patients and control group that were enrolled in either LSG or LRYGB with comparison of the 24-hours glucose fluctuations over a 10-day perioperative period using a continuous glucose monitoring system were conducted. Preoperative HbA<sub>1c</sub> levels did not significantly increase the chance of developing perioperative and postoperative complications, as well as prolonged hospital stay after LSG. HbA<sub>1c</sub> >7.3% increased the risk of hospital re-admission. The period of reactive hyperglycemia was recorded in response to the surgical trauma on the 1<sup>st</sup> and 2<sup>nd</sup> postoperative days after LSG and LRYGB. From the 3rd day, significantly lower mean daily glucose levels were observed in patients with DM2 after LRYGB compared to patients after LSG. Regardless of DM2, significantly lower mean daily glucose levels were present in all LRYGB patients at from 7<sup>th</sup> to 10</sup>th</sup> day as compared to the LSG.