title: Laparoscopic sleeve gastrectomy for morbid obesity and glucose metabolism: a new perspective.
abstract: BACKGROUND
  Global rise in the incidence of obesity and type 2 diabetes mellitus is widely recognized as one of the most challenging contemporary threats to public health. Weight loss surgery has proven to be an effective and durable solution for morbidly obese adults. Laparoscopic sleeve gastrectomy (LSG) was introduced as a restrictive procedure for obese patients, initially described as a possible first-stage operation, but now commonly performed as a stand-alone bariatric operation for both high-risk and super-morbid-obese patients, as well as for patients with lower body mass index. This study aims to evaluate the progression of glucose metabolism in patients undergoing LSG.
  
  
  METHODS
  This prospective study investigated 62 patients who underwent LSG by the same surgical team in an 18-month period. Preoperative evaluation included demographic information, complete medical history including comorbidities and medication, clinical examination, evaluation of cardiopulmonary function, measurement of weight and height on a standard electronic scale, upper gastrointestinal endoscopy and upper abdominal ultrasound, as well as interviews with a psychologist and nutritionist. Glucose metabolism was evaluated by oral glucose tolerance test (OGTT), preoperatively and at 3, 6, and 12 months after surgery.
  
  
  RESULTS
  The OGTT was significantly ameliorated in all groups during follow-up. Nine of 12 diabetic patients (75 %) ceased drug treatment at 3 months postoperatively (p = 0.004), increasing to 100 % at 1-year follow-up (p < 0.001). Normoglycemic patients and patients with borderline OGTT experienced mild or severe hypoglycemia during the glucose tolerance test at 3, 6, and 12 months' follow-up.
  
  
  CONCLUSIONS
  LSG offers excellent results to morbidly obese patients with regard to type 2 diabetes mellitus. Implementation of OGTT in these patients can be a valuable tool in their postoperative management. Bariatric teams performing LSG for morbid obesity should heighten their sensitivity to postoperative hypoglycemia, even in patients with type 2 diabetes mellitus.
authors.affiliation: Hippokration Athens General Hospital, 1st Propedeutic Surgical Clinic, Athens University School of Medicine, 10 Pasteur Str, 11521, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Natoudi
authors.forename: Sotirios-George
authors.initials: SG
authors.lastname: Panousopoulos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Memos
authors.forename: Evangelos
authors.initials: E
authors.lastname: Menenakos
authors.forename: George
authors.initials: G
authors.lastname: Zografos
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Leandros
authors.forename: Kostandinos
authors.initials: K
authors.lastname: Albanopoulos
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D005951:Glucose Tolerance Test; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose