Short-Term Diabetes Remission Outcomes in Patients with BMI ≤ 30 kg/m2 Following Sleeve Gastrectomy

Mid-Term Diabetes Remission Outcome in Patients with BMI ≤ 30 kg/m2 Following Sleeve Gastrectomy

BACKGROUND

Bariatric and metabolic surgery is recommended for Asian patients with type 2 diabetes mellitus (T2DM) and BMI ≥ 27.5 kg/m2. However, mid to long-term ·evidence is still lacking.

METHODS

Patients' data that underwent laparoscopic sleeve gastrectomy (SG) as the primary surgery at the Affiliated Hospital of Xuzhou Medical University were analyzed. Patients with T2DM diagnosed with either fasting blood glucose (FBG) ≥ 7.0 mmol/L or glycosylated hemoglobin (HbA1c) level ≥ 7.0% and 27.5 ≤ BMI ≤ 30 kg/m2 were included.

RESULTS

24 patients (7 male and 17 female) were included in this study. With a mean follow-up duration of 4.5 ± 1.1 years, the mean percentage of total weight loss (%TWL) was 14.4 ± 6.7%. Postoperatively, nine patients (37%) still required oral anti-diabetic medications, while no patients used insulin. FBG and HbA1c levels declined to 6.3 ± 1.5 mmol/L and 6.0 ± 1.0%, respectively. Fifteen patients (63%) were with HbA1c levels < 7% and without medication requirements, five patients (21%) were with HbA1c levels < 7% with the help of oral anti-diabetic medication, and four patients (16%) were with HbA1c levels > 7% with the help of oral anti-diabetic medication.

CONCLUSIONS

Our study provides further evidence that SG could result in both T2DM improvement and remission in patients with BMI ≤ 30 kg/m2. Longer follow-up duration and larger sample will be needed in the future.

Effect of Sleeve Gastrectomy on Plasma Thioredoxin-Interacting Protein (TXNIP)

PURPOSE

The mechanism in which bariatric surgery induces diabetes remission is still poorly understood. This study proposes Thioredoxin-interacting protein (TXNIP) as a possible factor for the anti-diabetic mechanism after sleeve gastrectomy (SG).

MATERIALS AND METHODS

Plasma TXNIP level in obesity patients with diabetes (T2D, N = 20), obesity patients without diabetes (NDO, N = 20), and patients without obesity and diabetes (lean, N = 10) were assessed before surgery and at 1 and 12 months after SG.

RESULTS

Preoperative TXNIP level was significantly higher in T2D (196.4 ± 76.0 pg/ml) and NDO (149.7 ± 94.1 pg/ml) patients when compared with lean patients (98.7 ± 22.7 pg/ml) (p-value < 0.05). At 1 month and 12 months postoperatively, the TXNIP levels were reduced significantly from the preoperative levels in the T2D and NDO patients (p-value < 0.05). Before surgery, a correlation between TXNIP and fasting blood glucose (FBG) (r² = 0.1585, p-value = 0.0109), HbA1C (r² = 0.2120, p-value = 0.0028), and insulin (r² = 0.1217, p-value = 0.0274) was observed. At 12 months after surgery, the reduction of TXNIP was also correlated with the degree of FBG (r² = 0.1038, p-value = 0.0426), HbA1C (r² = 0.2459, p-value = 0.0011), and insulin (r² = 0.1365, p-value = 0.0190) reduction.

CONCLUSION

Plasma TXNIP level is elevated in obesity patients with/without diabetes. SG resulted in a significant reduction of plasma TXNIP level which is correlated with the degree of FBG, HbA1C, and insulin reduction. Regulation of TXNIP could be part of the mechanism of diabetes remission after bariatric surgery.

Comparing the Anti-diabetic Effect of Sleeve Gastrectomy with Transit Bipartition Against Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Using a Diabetic Rodent Model

PURPOSE

Roux-en-Y gastric bypass (RYGB) has superior long-term diabetes remission outcomes to sleeve gastrectomy (SG). However, in regions with a high prevalence of gastric cancer, RYGB may not be the best option. This study aimed to investigate the anti-diabetic effect of SG with transit bipartition (SG-TB) compared with SG and RYGB.

MATERIALS AND METHODS

A total of 32 diabetic Sprague-Dawley rat models were assigned to one of four groups: SG (n = 8), RYGB (n = 8), SG-TB (n = 8), and SHAM (n = 8). Body weight, food intake, blood glucose, and hormonal changes (glucagon-like peptide-1 (GLP-1), insulin, and glucagon) were measured to investigate the effect of surgery in all groups. Oral glucose tolerance test and insulin tolerance test were performed before and 8 weeks after surgery.

RESULTS

There were no significant differences in the postoperative changes in body weight and food intake among the SG, RYGB, and SG-TB groups. Postoperatively, the RYGB and SG-TB groups had significantly higher GLP-1 levels and lower insulin levels than the SG group. Further, RYGB and SG-TB had significantly better glucose control improvements than SG. There were no significant differences in GLP-1, insulin, glucagon, and homeostasis model assessment of insulin resistance levels between RYGB and SG-TB. The preoperative and postoperative values of all variables in the SHAM group did not show significant differences.

CONCLUSION

In this study using a diabetes-induced rodent model, we found that the anti-diabetic effect of SG-TB is superior to that of SG and non-inferior to that of RYGB.

Short-Term Results Suggest That Sleeved Stomach without Resection Is as Effective as Sleeve Gastrectomy in Improving Glucose Control in Type 2 Diabetes Mellitus Sprague-Dawley Rat Model

Background

Although sleeve gastrectomy results in good weight loss and metabolic improvements, it is an irreversible procedure. Therefore, we attempted to assess the possibility of creating a sleeved stomach without resection. Material and Methods. A total of 22 male Sprague-Dawley rats with type 2 diabetes were randomly assigned into 3 different groups: (1) sleeve gastroplasty with gastric remnant-jejunal anastomosis (SGP, n = 8); (2) sleeve gastrectomy (SG, n = 8); and (3) SHAM (n = 6). Body weight, food intake, fasting blood glucose (FBG), hormonal analysis, and oral glucose tolerance test (OGTT) were performed and measured preoperatively and postoperatively.

Results

During the postoperative period, SGP and SG showed significantly lower food intake and body weight when compared with the preoperative levels, respectively (p value < 0.05). Postoperatively, SGP and SG showed improvements in FBG and glucose tolerance levels compared to their respective preoperative levels (p < 0.05). FBG and glucose tolerance levels did not differ between SGP and SG postoperatively. SG resulted in a reduction in fasting ghrelin levels when compared with the preoperative level (p < 0.05). Fasting insulin levels did not differ preoperatively and postoperatively among all groups. Postoperatively, fasting GLP-1 levels were higher in SGP and SG when compared with the preoperative levels, but no statistical significance was observed. Compared preoperatively, the SGP and SG procedures resulted in a decline in HOMA-IR at postoperative 6th week (p < 0.05).

Conclusion

Our animal experiment suggested that at least in the short term, sleeved stomach without resection resulted in similar weight loss and improved glucose control effects compared to sleeve gastrectomy.