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Can Sleeve Gastrectomy "Cure" Diabetes? Long Term Metabolic Effects of Sleeve Gastrectomy in Patients with Type 2 Diabetes
Ali Aminian*, Stacy A Brethauer*, Amin Andalib*, Suriya Punchai*, Jennifer Mackey*, John Rodriguez*, Tomasz Rogula*, Matthew Kroh*, Philip R Schauer
Cleveland Clinic, Cleveland, OH

OBJECTIVE(S):Laparoscopic sleeve gastrectomy (LSG) is rapidly gaining popularity. However, its long-term metabolic effects in patients with type 2 diabetes mellitus (T2DM) are unknown.
METHODS:Outcomes of 125 obese patients with T2DM who underwent LSG at an academic center during 2005-2010 and had at least 5-year follow-up were assessed.
RESULTS:At a median postsurgical follow-up of 6 years (range: 5-10), a mean BMI change of -8.9 kg/m^2 was associated with a reduction in mean HbA1c (-1.3%,p<0.001), fasting blood glucose (-41.1 mg/dL,p<0.001) and median number of antidiabetic medications (-1,p<0.001). Long-term glycemic control (HbA1c<7%), diabetes remission (HbA1c<6.5% off medications), complete remission (HbA1c<6% off medications), and “cure” (complete remission for ≥5 years) achieved in 64%, 25%, 6%, and 3%, respectively. Long-term recurrence of T2DM after initial remission occurred in 44% and was associated with more baseline antidiabetic medications (p=0.02). A significant improvement in triglycerides (-66.3±115 mg/dL,p<0.001), HDL (8.2±12.7 mg/dL,p<0.001), systolic (-10±19.8 mmHg,p<0.001), and diastolic blood pressure (-2.6±13.1 mmHg,p=0.45) was observed.
CONCLUSIONS:The findings of this study, which is the largest series with the longest follow-up time to date, indicate that LSG can significantly improve cardiometabolic risk factors including glycemic status in T2DM. However, unlike GI bypass procedures, long-term complete remission and “cure” of T2DM occur very infrequently.


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