title: Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  There are a dearth of studies comparing laparoscopic sleeve gastrectomy (LSG) and intensive medical treatment (IMT) in obese type 2 diabetes mellitus (T2DM) patients. This study compares these modalities in terms of weight loss, metabolic parameters and quality of life (QOL) score.
  
  
  METHODS
  We evaluated the efficacy of LSG (n = 14) vs. IMT (n = 17) comprising of low calorie diet, exenatide, metformin and if required insulin detemir in 31 obese T2DM patients with BMI of 37.9 ± 5.3kg/m(2) and target HbA1c < 7 %. The mean (±SD) age of the patients was 49.6 ± 11.9 years and 74 % were women. The mean duration of diabetes was 8.5 ± 6.1 years and mean HbA1c was 8.6 ± 1.3 %. Primary end point was excess body weight loss (EBWL) at the final follow-up.
  
  
  RESULTS
  The mean duration of follow-up was 12.5 ± 5.0 (median 12) months. EBWL was 61.2 ± 17.6 % and 27.4 ± 23.6 % in LSG and IMT group respectively (p < 0.001). Glycemic outcomes improved in both with mean HbA1c of 6.6 ± 1.5 % in LSG and 7.1 ± 1.2 % in IMT group. In LSG group, there was resolution of diabetes and hypertension in 36 and 29 % of patients respectively while none in the IMT group. HOMA-IR, hsCRP, ghrelin and leptin decreased while adiponectin increased significantly in LSG compared to IMT group. QOL score improved in LSG as compared to IMT.
  
  
  CONCLUSIONS
  In obese T2DM patients, LSG is superior to IMT in terms of weight loss, resolution of comorbidities and QOL score.
authors.affiliation: Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India, gauravpalikhe@hotmail.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Palikhe
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: B N
authors.initials: BN
authors.lastname: Behera
authors.forename: Naresh
authors.initials: N
authors.lastname: Sachdeva
authors.forename: Prathosh
authors.initials: P
authors.lastname: Gangadhar
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D000077270:Exenatide; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069057:Insulin Detemir; D049528:Insulin, Long-Acting / Q000627:therapeutic use; D010535:Laparoscopy; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use; D011788:Quality of Life; D016896:Treatment Outcome; D014688:Venoms / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D010455:Peptides; D014688:Venoms; D000069057:Insulin Detemir; D008687:Metformin; D000077270:Exenatide