PMID- 19866235
OWN - NLM
STAT- MEDLINE
DCOM- 20100817
LR  - 20220408
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 24
IP  - 5
DP  - 2010 May
TI  - Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and 
      adjustable gastric banding on type 2 diabetes.
PG  - 1005-10
LID - 10.1007/s00464-009-0715-9 [doi]
AB  - BACKGROUND: This study aimed to compare the efficacy of laparoscopic sleeve 
      gastrectomy (SG) with that of laparoscopic gastric bypass (GBP) and laparoscopic 
      adjustable gastric banding (AGB) for glucose homeostasis in morbidly obese 
      subjects with type 2 diabetes mellitus (T2DM) at a 3-year follow-up assessment 
      and to elucidate the role of weight loss in the T2DM resolution after SG. 
      METHODS: For this study, 60 morbidly obese T2DM patients (44 females and 16 
      males) who underwent AGB (24 patients), GBP (16 patients), or SG (20 patients) 
      between 1996 and 2008 were retrospectively analyzed. Age, sex, body mass index 
      (BMI), estimated weight loss (EWL), fasting glycemia, HbA1c, euglycemic 
      hyperinsulinemic clamp, discontinuation of diabetes treatment, and time until 
      interruption of therapy were evaluated. RESULTS: In the study, 54 patients 
      received oral hypoglycemic agents for at least 12 months before surgery, and 6 
      patients received insulin. The mean follow-up period was 36 months. The 
      resolution rate was 60.8% for the AGB patients, 81.2% for the GBP patients, and 
      80.9% for the SG patients. The postoperative time until interruption of therapy 
      was 12.6 months for the AGB patients, 3.2 months for the GBP patients, and 3.3 
      months for the SG patients. The hyperinsulinemic euglycemic clamp test was 
      performed 12 months after surgery for the cured patients. Insulin resistance was 
      restored to normal values in all the patients. The greatest improvement from 
      preoperative values occurred in the SG group. For the not-cured GBP and SG 
      patients, an improvement of 120 mg/dl in fasting plasma glucose was observed 3 
      months after the surgery, suggesting an enhancement in insulin sensitivity, which 
      determines better medical control. The resolution rate remained constant at the 
      36-month follow-up evaluation in both the GBP and SG groups. CONCLUSIONS: All 
      three bariatric procedures are effective in treating diabetes, with a 3-year 
      follow-up evaluation showing an effect that lasts. The AGB procedure was the 
      least effective. The antidiabetic effect was similarly precocious after GBP and 
      SG compared with AGB. This difference may indicate that a hormonal mechanism may 
      be involved, independent of weight loss.
FAU - Abbatini, F
AU  - Abbatini F
AD  - Department of Surgical-Medical Digestive Diseases, Policlinico Umberto I, 
      University La Sapienza, Viale del Policlinico, 00161 Rome, Italy.
FAU - Rizzello, M
AU  - Rizzello M
FAU - Casella, G
AU  - Casella G
FAU - Alessandri, G
AU  - Alessandri G
FAU - Capoccia, D
AU  - Capoccia D
FAU - Leonetti, F
AU  - Leonetti F
FAU - Basso, N
AU  - Basso N
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20091029
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
RN  - 0 (Blood Glucose)
SB  - IM
MH  - Blood Glucose/metabolism
MH  - Body Mass Index
MH  - Diabetes Mellitus, Type 2/blood/*complications
MH  - Female
MH  - Follow-Up Studies
MH  - Gastrectomy/*methods
MH  - Gastric Bypass/*methods
MH  - Gastroplasty/*methods
MH  - Humans
MH  - Insulin Resistance/*physiology
MH  - Laparoscopy/*methods
MH  - Male
MH  - Middle Aged
MH  - Obesity, Morbid/complications/*surgery
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Weight Loss/physiology
EDAT- 2009/10/30 06:00
MHDA- 2010/08/18 06:00
CRDT- 2009/10/30 06:00
PHST- 2009/04/27 00:00 [received]
PHST- 2009/09/26 00:00 [accepted]
PHST- 2009/10/30 06:00 [entrez]
PHST- 2009/10/30 06:00 [pubmed]
PHST- 2010/08/18 06:00 [medline]
AID - 10.1007/s00464-009-0715-9 [doi]
PST - ppublish
SO  - Surg Endosc. 2010 May;24(5):1005-10. doi: 10.1007/s00464-009-0715-9. Epub 2009 
      Oct 29.