Skip to main content

Five-Year Outcomes of Sleeve Gastrectomy in Patients with Class I Obesity and Type 2 Diabetes Mellitus



Several studies have reported short and medium-term outcomes of laparoscopic sleeve gastrectomy (LSG) in patients with class I obesity and type 2 diabetes mellitus (T2DM). However, literature on outcomes beyond three years is scarce. The present study discusses the 5-year results of a previously reported cohort of 20 patients with class I obesity and T2DM, who had undergone LSG between March 2012 and March 2015.

Materials and Methods

Patients were followed up in the bariatric clinic at yearly intervals as per institute protocol. Primary outcome was proportion of patients with a glycated haemoglobin (HbA1c) level of 6.5% or less, 5 years after LSG. Secondary outcomes were percentage total weight loss (%TWL), excess weight loss (EWL), weight regain and complications.


Out of 20 patients, 9 (45%) were male and 11 (55%) were female. Mean age was 41.6 ± 9.5 years. Mean pre-operative weight and BMI were 94.8 ± 14.4 kg and 33.4 ± 1.2 kg/m2, respectively. Median duration of diabetes was 42 months. Mean pre-operative fasting plasma glucose (FPG) and HbA1c were 171.1 ± 56.8 mg/dL and 8.7 ± 1.6%, respectively. Of the 17 patients available for follow-up at 5 years, 9 (52.9%) achieved HbA1c < 6.5% without medication, while 7 (41.2%) patients had improvement of their glycaemic status. One patient had recurrence of diabetes after initial remission. Mean %TWL and %EWL were 18% and 65.1%, respectively.


Laparoscopic sleeve gastrectomy is a reasonable option as a metabolic procedure for patients with T2DM and class I obesity.

Graphical abstract

This is a preview of subscription content, access via your institution.


  1. Jackson HT, Anekwe C, Chang J, Haskins IN, Stanford FC. The role of bariatric surgery on diabetes and diabetic care compliance. Curr Diab Rep. 2019;19:1–9.

    Article  Google Scholar 

  2. Singh AK, Singh R, Kota SK. Bariatric surgery and diabetes remission: who would have thought it? Indian J Endocrinol Metab. 2015;19:563.

    CAS  Article  Google Scholar 

  3. Vigneshwaran B, Wahal A, Aggarwal S, Priyadarshini P, Bhattacharjee H, Khadgawat R, et al. Impact of sleeve gastrectomy on type 2 diabetes mellitus, gastric emptying time, glucagon-like peptide 1 (GLP-1), Ghrelin and leptin in non-morbidly obese subjects with BMI 30–35.0 kg/m2: a prospective study. Obes Surg. 2016;26:2817–23.

    CAS  Article  Google Scholar 

  4. Wickremesekera K, Miller G, Naotunne TD, Knowles G, Stubbs RS. Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study. Obes Surg. 2005;15:474–81.

    Article  Google Scholar 

  5. Jørgensen NB, Bojsen-Møller KN, Dirksen C, Martinussen C, Svane MS, Kristiansen VB, et al. Sustained improvements in glucose metabolism late after Roux-En-Y gastric bypass Surgery in Patients with and Without Preoperative Diabetes. Sci Rep. 2019;9:15154.

    Article  Google Scholar 

  6. DePaula AL, Macedo ALV, Rassi N, Machado CA, Schraibman V, Silva LQ, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc. 2008;22:706–16.

    CAS  Article  Google Scholar 

  7. DePaula AL, Macedo ALV, Mota BR, Schraibman V. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2009;23:1313–20.

    CAS  Article  Google Scholar 

  8. Ozsoy Z, Demir E. Which bariatric procedure is the most popular in the world? A bibliometric comparison Obes Surg. 2018;28:2339–52.

    Article  Google Scholar 

  9. Wu D, Wang L, Jiang T. Efficacy comparison of laparoscopic sleeve gastrectomy in type 2 diabetes patients with a BMI 30-34.9 kg/m2 versus BMI < 30 kg/m2. Surg Endosc. 2021;35:1544–50.

    Article  Google Scholar 

  10. Abbatini F, Capoccia D, Casella G, Coccia F, Leonetti F, Basso N. Type 2 diabetes in obese patients with body mass index of 30–35 kg/m2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis. 2012;8:20–4.

    Article  Google Scholar 

  11. Lee W-J, Ser K-H, Chong K, Lee Y-C, Chen S-C, Tsou J-J, 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 

  12. Voorwinde V, Steenhuis IHM, Janssen IMC, Monpellier VM, van Stralen MM. Definitions of long-term weight regain and their associations with clinical outcomes. OBES SURG. 2020;30:527–36.

    Article  Google Scholar 

  13. Brethauer SA, Kim J, el Chaar M, Papasavas P, Eisenberg D, Rogers A, et al. Standardized outcomes reporting in metabolic and bariatric surgery. OBES SURG. 2015;25:587–606.

    Article  Google Scholar 

  14. Yang J, Wang C, Cao G, Yang W, Yu S, Zhai H, et al. Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28–35 kg/m(2). BMC Surg. 2015;15:88.

    Article  Google Scholar 

  15. Lee W-J, Chong K, Lin Y-H, Wei J-H, Chen S-C. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg. 2014;24:1552–62.

    Article  Google Scholar 

  16. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric Surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  Google Scholar 

  17. Seki Y, Kasama K, Kikkawa E, Yokoyama R, Nabekura T, Sano A, et al. Five-year outcomes of laparoscopic sleeve gastrectomy in Japanese patients with class I obesity. Obes Surg. 2020;30:4366–74.

    Article  Google Scholar 

  18. Sha Y, Huang X, Ke P, Wang B, Yuan H, Yuan W, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Surg. 2020;30:1660–70.

    Article  Google Scholar 

  19. Li Q, Chen L, Yang Z, Ye Z, Huang Y, He M, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index < 35 kg/m2. Diabetes Obes Metab. 2012;14:262–70.

    CAS  Article  Google Scholar 

  20. Cohen RV, Pinheiro JC, Schiavon CA, Salles JE, Wajchenberg BL, Cummings DE. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420–8.

    Article  Google Scholar 

  21. Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28:481–4.

    Article  Google Scholar 

  22. Solouki A, Kermansaravi M, Davarpanah Jazi AH, Kabir A, Farsani TM, Pazouki A. One-anastomosis gastric bypass as an alternative procedure of choice in morbidly obese patients. J Res Med Sci [Internet]. 2018 [cited 2021 Apr 20];23. Available from:

  23. Park JY, Kim YJ. Efficacy of laparoscopic sleeve gastrectomy in mildly obese patients with body mass index of 30–35 kg/m(2). Obes Surg. 2015;25:1351–7.

    Article  Google Scholar 

  24. Feng X, Andalib A, Brethauer SA, Schauer PR, Aminian A. How safe is bariatric surgery in patients with class I obesity (body mass index 30–35 kg/m2)? Surg Obes Relat Dis. 2019;15:253–60.

    Article  Google Scholar 

  25. Fuchs T, Loureiro M, Both GH, Skraba HH, Costa-Casagrande TA. The role of the sleeve gastrectomy and the management of type 2 diabetes. Arq bras cir dig. 2017;30:283–6.

    Article  Google Scholar 

  26. Tsilingiris D, Koliaki C, Kokkinos A. Remission of type 2 diabetes mellitus after bariatric surgery: fact or fiction? Int J Environ Res Public Health. 2019;16(17):3171.

  27. Pratley RE, Weyer C. The role of impaired early insulin secretion in the pathogenesis of Type II diabetes mellitus. Diabetologia. 2001;44:929–45.

    CAS  Article  Google Scholar 

  28. Koliaki C, Liatis S, le Roux CW, Kokkinos A. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocr Disord. 2017;17:50.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations



Devender Singh - Acquisition and analysis of data, drafting and final approval of manuscript.

Aditya Baksi - Design of work, interpretation of data, drafting and final approval of manuscript.

Prasanna Ramana - Acquisition of data, drafting and final approval of manuscript.

Vitish Singla - Analysis of data, drafting and final approval of manuscript.

Sandeep Aggarwal - Conception and design of work, critical revision and final approval of manuscript.

Corresponding author

Correspondence to Sandeep Aggarwal.

Ethics declarations

The study was undertaken after clearance from institutional ethical committee. There was no commission or omission of intervention for the study purpose, and all the interventions were done in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

A written informed consent was taken from each patient for the surgical procedure.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

• The positive impact of sleeve gastrectomy on glycaemic control in patients with class I obesity and type 2 diabetes is sustained at five years after surgery.

• Mean HbA1c decreased from 8.7% to 6.6% at five years after sleeve gastrectomy.

• More than 70% patients achieved HbA1c less than 6.5% at five years.

• More than half the patients were off anti-diabetic medication.

• All patients on insulin before surgery were off insulin at five years.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Singh, D., Baksi, A., Ramana, P. et al. Five-Year Outcomes of Sleeve Gastrectomy in Patients with Class I Obesity and Type 2 Diabetes Mellitus. OBES SURG 32, 96–102 (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Bariatric surgery
  • Metabolic surgery
  • Non-severe obesity
  • Long-term outcomes
  • T2DM