Laparoscopic Sleeve Gastrectomy for Type 2 Diabetes Mellitus: Long-Term Result and Recurrence of Diabetes



Laparoscopic sleeve gastrectomy (LSG) is becoming a primary bariatric/metabolic surgical procedure for treating obesity and related type 2 diabetes mellitus (T2D). This study presents the long-term outcome of LSG about the remission and recurrence of T2D.


A total of 59 obese patients (38 women and 21 male) with T2D (mean body mass index [BMI] 37.6 ± 5.1 kg/m2) who underwent LSG from 2006 to 2014 with complete 5 years followed up were selected for present study. The remission of T2D was evaluated in stratified groups using the ABCD scoring system which is composed of the age, BMI, C-peptide, and duration of T2D.


The weight loss at 5 years after surgery was 23.5% and the mean BMI decreased to 27.7 ± 4.5 kg/m2. The mean HbA1c decreased from 8.1 to 6.1% at 5 years. The 1-year and 5-year complete remission rate (HbA1c < 6.0%) was 62.7% and 42.4%. Thirteen patients (35.1%) out of 37 patients who had their T2D remission at 1 year had their T2D recurrent at 5 years. Patients with ABCD score higher than 5 had a higher long-term T2D remission rate and less recurrence of their T2D than those with ABCD score less than 5. The remission and recurrence of T2D after were associated with a weight loss more than 20%.


LSG is an effective procedure for T2D treatment but a significant portion of patients had their T2D recurrence at long-term. LSG is better recommended to patients with their ABCD score ≥ 5 and dedication to maintain a good weight loss is important.

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  1. 1.

    Wild S, Roglic G, Green A, et al. Global prevalence of diabetes for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–52.

    Article  Google Scholar 

  2. 2.

    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  Google Scholar 

  3. 3.

    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  Google Scholar 

  4. 4.

    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.

    Article  CAS  Google Scholar 

  5. 5.

    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  Google Scholar 

  6. 6.

    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.

    Article  CAS  Google Scholar 

  7. 7.

    Creange C, Sethi M, Fielding G, et al. The safety of laparoscopic sleeve gastrectomy among diabetes patients. Surg Endosc. 2017;31:907–11.

    Article  Google Scholar 

  8. 8.

    Shivakumar S, Tantia O, Goyal G. LSG vs MGB-OAGB-3 year follow-up data: a randomized control trial. Obes Surg. 2018;28(9):2820–8.

    Article  CAS  Google Scholar 

  9. 9.

    Garg H, Priyadarshini P, Aggarwal S, et al. Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: a case control study. World J Gastroenterol Endosc. 2017;9(4):162–70.

    Article  Google Scholar 

  10. 10.

    Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147:664–9.

    Article  Google Scholar 

  11. 11.

    Aminiam A, Brethauer SA, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650–7.

    Article  Google Scholar 

  12. 12.

    Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of multicenter prospective study at 1 year. Obes Surg. 2011;21(6):738–43.

    Article  Google Scholar 

  13. 13.

    Keidar A, Hershkop KJ, Marko L, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomized trial. Diabetologia. 2013;56(9):1914–8.

    Article  Google Scholar 

  14. 14.

    Murphy R, Clarke MG, Evennett NJ, et al. Laparoscopic sleeve gastrectomy versus banded Roux-en-Y gastric bypass for diabetes and obesity: a prospective randomized double-blind trial. Obes Surg. 2018;28(2):293–302.

    Article  Google Scholar 

  15. 15.

    Widjaja J, Pan H, Dolo PR, et al. Short-term diabetes remission outcomes in patients with BMI <30 kg/m2 following sleeve gastrectomy. Obes Surg. 2020;30(1):18–22.

    Article  Google Scholar 

  16. 16.

    American Diabetes Association. Screening for type 2 diabetes. Diabetes Care. 2004;27(Suppl 1):S11–4.

    Google Scholar 

  17. 17.

    Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs. sleeve gastrectomy for type 2 diabetes mellitus: a randomized trial. Arch Surg. 2011;146:204–9.

    Google Scholar 

  18. 18.

    Ser KH, Lee WJ, Lee YC, et al. Experience in laparoscopic sleeve gastrectomy for morbid obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;16:2253–9.

    Article  Google Scholar 

  19. 19.

    Lee WJ, Chen JC, Yao WC, et al. Transumbilical 2-site laparoscopic Roux-en-Y gastric bypass: initial results of 100 cases and comparison with traditional laparoscopic technique. Surg Obes Relat Dis. 2012;8(2):208–13.

    Article  Google Scholar 

  20. 20.

    Chiu CC, Lee WJ, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg. 2006;16(7):913–8.

    Article  Google Scholar 

  21. 21.

    Buse JB, Laughlin S, Caprio S, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.

    Article  Google Scholar 

  22. 22.

    Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9:379–84.

    Article  Google Scholar 

  23. 23.

    Lee WJ, Almulaifi A, Tsou JJ, et al. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by ABCD score. Surg Obes Relat Dis. 2015;11:991–7.

    Article  Google Scholar 

  24. 24.

    DiGiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis. 2010;6:249–53.

    Article  Google Scholar 

  25. 25.

    Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6:254–9.

    Article  Google Scholar 

  26. 26.

    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. NEJM. 2017;376:641–51.

    Article  Google Scholar 

  27. 27.

    Lee WJ, Chong K, Chen SC, et al. Pre-operative prediction of type 2 diabetes remission after gastric bypass surgery: a comparison of DiaRem scores and ABCD scores. Obes Surg. 2016;26(10):2418–24.

    Article  Google Scholar 

  28. 28.

    Chen JC, Hsu NY, Lee WJ, et al. Prediction of type 2 diabetes remission after metabolic surgery: a comparison of the individualized metabolic surgery score and the ABCD score. Surg Obes Relat Dis. 2018;14(5):640–5.

    Article  Google Scholar 

  29. 29.

    Naitoh T, Kasama K, Seki Y, et al. Efficacy of sleeve gastrectomy with duodenal-jejunal bypass for the treatment of obese severe diabetes patients in Japan: a retrospective multicenter study. Obes Surg. 2018;28:497–505.

    Article  Google Scholar 

  30. 30.

    Haruta H, Kasama K, Ohta M, et al. Long-term outcomes of bariatric and metabolic surgery in Japan: results of a multi-instituitional survey. Obes Surg. 2017;27(3):754–62.

    Article  Google Scholar 

  31. 31.

    Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanism of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.

    Article  CAS  Google Scholar 

  32. 32.

    Lee WJ, Chen CY, Chong K, et al. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:683–90.

    Article  Google Scholar 

  33. 33.

    Yousseif A, Emmanuel J, Karra E, et al. Differential effects of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on appetite, circulating acryl-ghrelin, peptide YY3-36 and active GLP-1 levels in non-diabetic humans. Obes Surg. 2014;24:241–52.

    Article  Google Scholar 

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Correspondence to Wei-Jei Lee.

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No human or animal rights were violated in this study. This retrospective study did not require the participation of the subjects.

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Lee, MH., Almalki, O.M., Lee, WJ. et al. Laparoscopic Sleeve Gastrectomy for Type 2 Diabetes Mellitus: Long-Term Result and Recurrence of Diabetes. OBES SURG 30, 3669–3674 (2020).

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  • Type 2 DM
  • Sleeve gastrectomy
  • Recurrence
  • ABCD score