Resolution of Type 2 Diabetes After Sleeve Gastrectomy

Abstract

Objective: To determine the resolution of type-II diabetes mellitus (DM) after sleeve gastrectomy (SG) among patients by evaluating glycemic control, medication use, and weight loss.

Methodology: A prospective observational study was done at the Nescom hospital, Islamabad, from August 2022 to September 2023. Both male and female individuals aged 18 years old or above, morbidly obese with BMI  greater than35 kg/m and with diagnosis of type –II DM undergoing laparoscopic sleeve gastrectomy were included. Laparoscopic sleeve gastrectomy was done using a standardized four-port technique. A possible large curvature of the stomach was resected, starting 6 cm proximal to the pylorus up to the angle of His. The 36-Fr bougie was used to calibrate the sleeve. Postoperative care started with a liquid diet and structured follow-up at POD3, 2 weeks, and 6 months. At each visit, BMI, fasting glucose, and HbA1c were recorded. Data were documented on a study proforma and analyzed using SPSS version 26.

Results: Overall mean age of the individuals was 47 ± 8 years with 63.3% being female and 36.7% males. Before the surgeries, 66.7% required hypoglycemic drugs and 53.3% were on insulin. Average HbA1c decreased significantly from 8.9% preoperatively to 8.2% on POD3, 7.1% at 2 weeks, and 5.9% at 6 months (p < 0.001). The plasma glucose levels declined from 202.7 mg/dL (POD3) to 138.4 mg/dL at 2 weeks and 100.8 mg/dL at 6 months (p < 0.001). Additionally, the excess weight loss was improved steadily, from 4.1% at POD3 to 11.7% at 2 weeks and 35.1% at 6 months (p < 0.001). However, there were no significant gender-based differences were observed in HbA1c, plasma glucose, excess weight loss, or BMI (all p > 0.05).

Conclusion: LSG is an effective intervention for achieving significant weight loss, improving glycemic control, and reducing plasma glucose levels in Pakistani patients with T2D. These findings support the use of LSG as a valuable tool for managing obesity-related T2D in diverse populations. Further research with larger sample sizes and longer follow-up periods is recommended to validate these results and elucidate the underlying mechanisms.