Effect of Laparoscopic Sleeve Gastrectomy on Type 2 Diabetes Mellitus in Patients with Body Mass Index less than 30 kg/m2.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been proved to be the most effective treatment strategy for the treatment of type 2 diabetes mellitus (T2DM) with a body mass index ≥ 30 kg/m2 achieving high remission rates. However, there are few clinical studies on the treatment of T2DM patients with a body mass index less than 30 kg/m2 by LSG. This study aims to study the effect of LSG on type 2 diabetes mellitus(T2DM) in patients with a body mass index (BMI) less than 30 kg/m2.
METHODS: The clinical data of 25 patients with type 2 diabetes mellitus (T2DM) and body mass index 23.23-29.97 kg/m2 who were treated by LSG at the Department of Bariatric and Metabolic Surgery in China-Japan Union Hospital of Jilin University from May 2016 to May 2017 were retrospectively analyzed. The changes of fasting plasma glucose, glycosylated hemoglobin, insulin resistance index, body weight, body mass index, waist circumference, blood pressure, heart rate, blood lipids, and uric acid were analyzed at 3 months, 6 months, and 12 months after operation, respectively. All the clinical data were analyzed by SPSS 22.0. They were tested with a single-sample K-S test to determine whether they were normal distribution data. The normal distribution data were analyzed by a matched t test, and the Mann-Whitney test was used to examine skewed data.
RESULTS: All patients (9 males, 16 females) with a median age of 57(24~65) years were treated successfully by laparoscopic sleeve gastrectomy. The median duration of type 2 diabetes mellitus was 10(0~20)years. The preoperative fasting plasma glucose, glycosylated hemoglobin, body weight, body mass index, and waist circumference were 10.32 ± 2.66 mmol/L,8.20 ± 1.47%,76.54 ± 10.02 kg,27.92 ± 1.72 kg/m2, and 99.88 ± 5.38 cm, respectively. The meaning fasting plasma glucose was 7.26 ± 1.36 mmol/L, 6.90 ± 1.07 mmol/L, and 6.62 ± 0.97 mmol/L, respectively, at 3, 6, and 12 months after operation. The mean HbAlc in the same observation intervals was 6.88 ± 1.23%,6.54 ± 1.02%, and 6.51 ± 0.89%, respectively. The body weight was 62.18 ± 8.38 kg,59.07 ± 8.58 kg, and 58.62 ± 8.53 kg, respectively. The corresponding body mass index was 22.56 ± 1.56 kg/m2, 21.35 ± 1.58 kg/m2, and 21.24 ± 1.86 kg/m2, respectively. The waist circumference was 82.84 ± 5.10 cm,78.60 ± 5.21 cm, and 76.92 ± 5.21 cm, respectively. The complete remission rates of type 2 diabetes mellitus were 40%, 60%, and 68%, respectively, at 3, 6, and 12 months after operation. The complete remission rates for insulin resistance index were 52.4%, 80%, and 80%, postoperatively, at 3, 6, and 12 months, respectively. The complete remission rates of hypertension were 22.2%, 50%, and 75%,respectively, at 3,6, and 12 months after operation. The complete remission rates of hypertriglyceridemia were 66.7%, 66.7%, and 100%,and the complete remission rates of hypercholesterolemia were 41.7%, 60%, and 100%;the abnormal elevations of plasma cholesterol in two patients with normal cholesterol before operation were significantly higher, postoperatively, at 3 monthsand 6 months, respectively. The complete remission rates of hyperuricemia were 37.5%, 33.3%, and 100% in the same observation period, respectively. The abnormal elevations of uric acid in two patients with normal uricemia before operation were significantly higher at postoperative 3 months.
CONCLUSION: LSG has a significant effect on patients with type 2 diabetes mellitus whose BMI less than 30 kg/m2 in a short time, but its long-term effectiveness needs to be further followed up.