title: Laparoscopic sleeve gastrectomy and medical management for the treatment of type 2 diabetes mellitus in non-morbidly obese patients: a single-center experience.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) and obesity are often associated in the same metabolic pathology and represent a significant public health problem. Although laparoscopic sleeve gastrectomy (LSG) is a relatively recent technique of bariatric surgery, it has shown to be efficient and safe and has obtained much support from physicians and patients. Several studies have highlighted the effects in terms of resolution and improvement of diabetes.
  
  
  METHODS
  From January 2009 to November 2012, 15 patients in Obesity Class II (body mass index [BMI], 37.9 ± 1.5 kg/m(2); baseline weight, 102.7 ± 11.6 kg) with uncontrolled T2DM despite taking a glucose-lowering drug therapy (glycated hemoglobin [HbA1c], 8.1 ± 0.6%) underwent LSG and advanced practice medical management in accordance with the American Diabetes Association guidelines. All patients were subjected to follow-up controls with anthropometric and metabolic indices at 5, 15, 30, and 60 days, and at 6 and 12 months after surgery, remission of diabetes was also evaluated.
  
  
  RESULTS
  At 1 year after surgery, the mean excess weight loss percentage (EWL%) was 58.4%, and the mean BMI had decreased from the preoperative value of 37.9 kg/m(2) to 30.4 kg/m(2). The average reduction in HbA1c was 2.5 (30.9%). The mean homeostatic model assessment of insulin resistance decreased from 13.3 to 4.9. Overall, during the period of observation, four patients (26.7%) had started drug therapy again, six patients had complete remission (40%), and five patients had partial remission (33.3%).
  
  
  CONCLUSIONS
  LSG not only makes it possible to attain a significant EWL% in obese patients, but also a remission or improvement of diabetes. Further studies are required to determine the duration of the effect and the role of different factors involved.
authors: Department of Digestive Surgery and Liver Unit, St Maria Hospital, Terni, Italy.
authors: Jacopo
authors: J
authors: Desiderio
authors: Stefano
authors: S
authors: Trastulli
authors: Vittorio
authors: V
authors: Scalercio
authors: Roberto
authors: R
authors: Cirocchi
authors: Giancarlo
authors: G
authors: Carloni
authors: Eleonora
authors: E
authors: Moriconi
authors: Carlo
authors: C
authors: Boselli
authors: Giuseppe
authors: G
authors: Noya
authors: Amilcare
authors: A
authors: Parisi
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012074:Remission Induction; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human