Endocrine Abstracts

Background: Type 2 diabetes mellitus became a global problem during recent decades, and unfortunately medical treatment fails to provide adequate control in many obese diabetics. We aimed to perform a prospective comparative cohort study to investigate how soon patients achieve glycemic control after three different surgical options (sleeve gastrectomy (SG), mini-gastric bypass (MGB), diverted sleeve gastrectomy with ileal transposition (DSIT)) within the first 30 days postoperatively.

Methods: Medical charts of 251 obese, type 2 diabetic patients with a mean age of 52.84±8.52 were used to assess daily changes in weight and plasma glucose levels. Patients had a mean diabetic duration of 13.09±7.54 years, mean HbA1c of 8.82±1.58%, and a mean BMI of 36.04±5.76 kg/m².Surgery types consisted of SG (n=49), MGB (n=93) and DSIT (n=109). Primary end point was the day of mean fasting plasma glucose levels reaching below 126 mg/dl within 30 days after surgery.

Results: In the morning of surgery, mean fasting plasma glucose levels was 177.63±51.3 mg/dl, while on the 30th day, it was 131.35±28.7 mg/dl (P<0.05). According to the type of surgery, SG group did not achieve a mean plasma glucose level <126 mg/dl within the first 30 days, postoperatively. Mean plasma glucose level reaching <126 mg/dl was achieved on day 29 for DSIT (124.36±20.21 mg/dl) and on day 30 for MGB (123.61±22.51 mg/dl).

Conclusion: We observed differences in glycemic control following different types of surgery within the first 30 postoperative days. Patients in the SG group did not achieve a mean plasma glucose level <126 mg/dl. Mean fasting plasma glucose levels <126 mg/dl were achieved on day 29 for DSIT and on day 30 for the MGB. Multivariate logistic regression analysis identified preoperative BMI and postprandial C-peptide level as independent predictors of postoperative glycemic control in the DSIT group.

Keywords: Bariatric surgery; glycemic control; sleeve gastrectomy; mini-gastric bypass; diverted sleeve gastrectomy with ileal transposition.