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

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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.

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Acknowledgments

The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/wswqg5

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Authors and Affiliations

  1. Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Hastanesi Sok., Kent Pasaji, Kat: 1-2, Sisli, Istanbul, Turkey

    Alper Celik, Deniz Büyükbozkırlı & Yunus Emre Kılıç

  2. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Sjaak Pouwels

  3. Department of Endocrinology, GATA Haydarpaşa Training & Research Hospital, Istanbul, Turkey

    Fatih Can Karaca & Eylem Çağıltay

  4. Kirloskar Hospital, Bariatric & Metabolic Surgery Clinic, Hyderabad, India

    Surendra Ugale

  5. Faculty of Medicine Department of Biostatistics, Near East University, Nicosia, Cyprus

    İlker Etikan

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  1. Alper Celik
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  4. Eylem Çağıltay
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Correspondence to Alper Celik.

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Conflict of Interest Statement

No conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

The study has been approved by the appropriate institutional and/or national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The authors declare that they have no funding.

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Celik, A., Pouwels, S., Karaca, F.C. et al. Time to Glycemic Control - an Observational Study of 3 Different Operations. OBES SURG 27, 694–702 (2017). https://doi.org/10.1007/s11695-016-2344-4

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