Sleeve Gastrectomy in Patients with Type 2 Diabetes: Anthropometric and Cardiometabolic Improvements at 1, 3, 5, 7, and 9 years—Are the Initial Benefits Sustained?

TL;DR

This study shows that sleeve gastrectomy leads to lasting weight loss and improved diabetes and heart health outcomes in patients with type 2 diabetes up to 9 years post-surgery.

Contribution

The study provides the first assessment of long-term outcomes beyond 5 years after sleeve gastrectomy in patients with type 2 diabetes.

Findings

Sleeve gastrectomy resulted in significant and sustained weight loss and BMI reduction over 9 years.

Fasting blood glucose and HbA1c levels improved significantly and remained stable long-term.

Most cardiometabolic markers, including blood pressure and cholesterol, showed sustained improvement.

Abstract

No previous study assessed the outcomes of sleeve gastrectomy (SG) beyond 5 years among adult patients with type 2 diabetes (T2DM). We appraised the evolution of 20 outcomes at 1, 3, 5, 7, and 9 years.

This is a retrospective study of 361 consecutive T2DM patients who underwent SG at our institution (April 2011–December 2015). Postoperative data were compared to baseline and to previous time points using paired t tests. Diabetes status was also assessed at each time point.

The sample consisted of 65.37% females. The mean preoperative age was 44.38 ± 9.50 years and body mass index (BMI) was 43.81 ± 6.98 kg/m2. Generally, most improvements occurred in the first year and were sustained on the long term. Postoperatively, there was a significant and sustained weight reduction, amounting to a mean decrease of 9 kg/m2 in BMI at year 9 and associated excess weight loss between 59%year 1 and 46%year 9. Fasting blood glucose decreased significantly across the five time points, from 9.27 ± 4.11preop to 7.06 ± 2.70 year 9 mmol/L. Mean HbA1c significantly decreased from 8.1%preop to 6.77%year 9. The prevalence of complete remission of T2DM was 20.45%, 19.44%, and 20% at 5, 7, and 9 years respectively, with significant reductions in percentages of patients using diabetes medications or insulin. Between 10% and 23% of patients experienced relapse of T2DM by 5–9 years. In comparison to baseline levels, mean blood pressure, triglycerides, high-density lipoprotein, low-density lipoprotein, total cholesterol, and hepatic enzymes levels all showed improvement in the long term.

Patients with T2DM experienced substantial improvements in most anthropometric and cardiometabolic outcomes within the first year, and these were sustained in the long term.

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