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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
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.
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.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
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.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.
Creange C, Sethi M, Fielding G, et al. The safety of laparoscopic sleeve gastrectomy among diabetes patients. Surg Endosc. 2017;31:907–11.
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.
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.
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.
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.
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.
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.
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.
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.
American Diabetes Association. Screening for type 2 diabetes. Diabetes Care. 2004;27(Suppl 1):S11–4.
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.
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.
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.
Chiu CC, Lee WJ, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg. 2006;16(7):913–8.
Buse JB, Laughlin S, Caprio S, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.
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.
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.
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.
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.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. NEJM. 2017;376:641–51.
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.
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.
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.
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.
Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanism of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.
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.
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.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
No human or animal rights were violated in this study. This retrospective study did not require the participation of the subjects.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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). https://doi.org/10.1007/s11695-020-04737-4
- Type 2 DM
- Sleeve gastrectomy
- ABCD score