title: Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus.
abstract: BACKGROUND
  To prospectively evaluate the efficacy and safety of laparoscopic sleeve gastrectomy (LSG) in Indian subjects with type 2 diabetes mellitus and a body mass index >33 kg/m(2) in a tertiary care hospital in Pune, India. Morbid obesity associated with type 2 diabetes mellitus has many health implications. A definitive long-term strategy is needed to control obesity and its deleterious effects. LSG is one such approach.
  
  
  METHODS
  The patients who underwent LSG were followed up until the end of 1 year after surgery. The change in hemoglobin A1c levels, waist circumference, total body weight, and the use of oral hypoglycemic agents and insulin were studied.
  
  
  RESULTS
  A total of 53 patients (24 men and 29 women, age 46.5 +/- 8.7 years, body mass index 45.2 +/- 9.3 kg/m(2), waist circumference 117 +/- 18 cm, and hemoglobin A1c 8.4% +/- 1.6%) fulfilled the entry criteria and underwent LSG. Before LSG, 48 patients (79%) required antidiabetic medication (oral hypoglycemic agents and insulin) and 5 managed their diabetes with diet control. At 1 month after LSG, 39 (81.2%) of 48 patients no longer required antidiabetic medications and had achieved euglycemia with diet control alone. The use of antidiabetic medications was reduced in 9 (18.8%) of 52 patients. At 1 year, euglycemia was observed in 51 patients (96.2%) without medication and 2 (3.8%) of the 53 patients had reduced their medication dosage.
  
  
  CONCLUSIONS
  LSG is an effective adjunct in the treatment of type 2 diabetes mellitus in obese individuals. It appears that improvement in glycemic control is achieved even before weight reduction, and the possible mechanisms explaining this need further investigation.
authors.affiliation: Laparoscopic and Bariatric Surgery, Ruby Hall Clinic, Pune, Maharashtra, India.
authors.forename: Poonam S
authors.initials: PS
authors.lastname: Shah
authors.forename: Jayashree S
authors.initials: JS
authors.lastname: Todkar
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007194:India; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human