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Obes Surg. 2017 Mar;27(3):694-702. doi: 10.1007/s11695-016-2344-4.

Time to Glycemic Control - an Observational Study of 3 Different Operations.

Author information

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.

KEYWORDS:

Bariatric surgery; Diverted sleeve gastrectomy with ileal transposition; Glycemic control; Mini-gastric bypass; Sleeve gastrectomy

PMID:
27565665
DOI:
10.1007/s11695-016-2344-4
[Indexed for MEDLINE]

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