Glycemic control after bariatric surgery varies by surgery type

Patients with obesity and type 2 diabetes saw more improvement in glycemic control within 30 days of undergoing diverted sleeve gastrectomy with ileal transposition or mini-gastric bypass surgery vs. those undergoing sleeve gastrectomy, according to study findings presented at the European Congress of Endocrinology.

“Medical treatment fails to provide adequate control in many obese diabetics,” Alper Celik, MD, medical director of the Metabolic Surgery Clinic in Istanbul, and colleagues wrote. “We aimed to perform a prospective, comparative cohort study to investigate how soon patients achieve glycemic control after three different surgical options within the first 30 days postoperatively.”

Alper Celik

In a prospective chart review, Celik and colleagues analyzed the daily weight and plasma glucose levels of 251 adults with type 2 diabetes and obesity who underwent three types of bariatric surgery (mean age, 53 years; mean diabetes duration, 13 years; mean HbA1c, 8.8%; mean BMI, 36.04 kg/m²). Within the cohort, 49 underwent sleeve gastrectomy; 93 underwent mini-gastric bypass; 109 underwent diverted sleeve gastrectomy with ileal transposition. Primary endpoint was the day mean fasting plasma glucose fell to 126 mg/dL within 30 days of surgery.

Mean fasting plasma glucose for the cohort was 177.63 mg/dL at baseline; mean levels fell to 131.35 mg/dL on day 30 after surgery (P < .05). By day 30, the sleeve gastrectomy group did not reach a mean fasting plasma glucose of 126 mg/dL or less; however, patients undergoing diverted sleeve gastrectomy with ileal transposition had a mean fasting plasma glucose of 124.36 mg/dL by day 29; patients undergoing mini-gastric bypass had a mean fasting plasma glucose of 123.61 mg/dL by day 30.

In multivariate logistic regression, researchers found that preoperative BMI and postprandial C-peptide levels were independent predictors of glycemic control after surgery in the diverted sleeve gastrectomy group.

“Sleeve gastrectomy itself can lead to weight loss, but the degree of weight loss is not directly related to the glycemic improvement,” Celik told Endocrine Today. “Operations combining stomach reduction together with intestinal re-routing provide much higher rates of glycemic control, compared to operations based on stomach size restriction.”

Celik said he and his colleagues are currently conducting a cross-sectional, multicenter study on distal intestinal hormones and the change in their activity according to various types of surgeries. Preliminary data will be available before July 2017, he said. – by Regina Schaffer

Reference:

Celik A, et al. Abstract GP96. Presented at: European Congress of Endocrinology; May 28-31, 2016; Munich.

Disclosure: Celik reports no relevant financial disclosures.