Alper Celik1, Sjaak Pouwels2, Fatih Can Karaca3, Eylem Çağıltay3, Surendra Ugale4, İlker Etikan5, Deniz Büyükbozkırlı6, Yunus Emre Kılıç6. 1. Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Hastanesi Sok., Kent Pasaji, Kat: 1-2, Sisli, Istanbul, Turkey. doktoralper@hotmail.com. 2. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. 3. Department of Endocrinology, GATA Haydarpaşa Training & Research Hospital, Istanbul, Turkey. 4. Kirloskar Hospital, Bariatric & Metabolic Surgery Clinic, Hyderabad, India. 5. Faculty of Medicine Department of Biostatistics, Near East University, Nicosia, Cyprus. 6. Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Hastanesi Sok., Kent Pasaji, Kat: 1-2, Sisli, Istanbul, Turkey.
Abstract
BACKGROUND: Medical treatment fails to provide adequate control for many obese patients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT). METHODS: Included patients had a body mass index (BMI) ≥30 kg/m2; T2DM for ≥3 years, HbA1C > 7 % for ≥3 months, and no significant weight change (>3 %) within the prior 3 months. Surgical procedures performed were SG (n = 49), MGB (n = 93), and DSIT (n = 109). The primary endpoint was the day within the first postoperative month on which mean fasting capillary glucose levels reached <126 mg/dL. Multivariate logistic regression analysis was used to identify predictors of glycemic control. RESULTS: The cohort included 251 patients with a mean BMI of 36.04 ± 5.76 kg/m2; age, 52.84 ± 8.52 years; T2DM duration, 13.09 ± 7.54 years; HbA1C, 8.82 ± 1.58 %. On the morning of surgery, mean fasting plasma glucose was 177.63 ± 51.3 mg/dL; on day 30, 131.35 ± 28.7 mg/dL (p < 0.05). Mean fasting plasma glucose of <126 mg/dL was reached in the DSIT group (124.36 ± 20.21 mg/dL) on day 29, and in the MGB group (123.61 ± 22.51 mg/dL), on day 30. The SG group did not achieve target mean capillary glucose level within postoperative 30 days. CONCLUSION: During the first postoperative month, glycemic control (<126 mg/dL) was achieved following DSIT and MGB, but not SG. Preoperative BMI and postprandial C-peptide levels were independent predictors of early glycemic control following DSIT.
BACKGROUND: Medical treatment fails to provide adequate control for many obesepatients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT). METHODS: Included patients had a body mass index (BMI) ≥30 kg/m2; T2DM for ≥3 years, HbA1C > 7 % for ≥3 months, and no significant weight change (>3 %) within the prior 3 months. Surgical procedures performed were SG (n = 49), MGB (n = 93), and DSIT (n = 109). The primary endpoint was the day within the first postoperative month on which mean fasting capillary glucose levels reached <126 mg/dL. Multivariate logistic regression analysis was used to identify predictors of glycemic control. RESULTS: The cohort included 251 patients with a mean BMI of 36.04 ± 5.76 kg/m2; age, 52.84 ± 8.52 years; T2DM duration, 13.09 ± 7.54 years; HbA1C, 8.82 ± 1.58 %. On the morning of surgery, mean fasting plasma glucose was 177.63 ± 51.3 mg/dL; on day 30, 131.35 ± 28.7 mg/dL (p < 0.05). Mean fasting plasma glucose of <126 mg/dL was reached in the DSIT group (124.36 ± 20.21 mg/dL) on day 29, and in the MGB group (123.61 ± 22.51 mg/dL), on day 30. The SG group did not achieve target mean capillary glucose level within postoperative 30 days. CONCLUSION: During the first postoperative month, glycemic control (<126 mg/dL) was achieved following DSIT and MGB, but not SG. Preoperative BMI and postprandial C-peptide levels were independent predictors of early glycemic control following DSIT.
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