title: Immediate Metabolic Response Following Sleeve Gastrectomy in Obese Diabetics.
abstract: BACKGROUND
  Although laparoscopic sleeve gastrectomy (LSG) has been shown to have a long-term antidiabetic effect, little is known regarding the immediate response to surgery. This study's objective was to evaluate the glycemic and lipid metabolic response in the first postoperative week.
  
  
  METHODS
  The study included 21 obese diabetic participants. Glycemic markers, lipids, and hepatic function tests were measured just prior to surgery and at 1 week and 3 months postoperatively. Two participants were dropped prior to all measurements due to technical reasons, and two more were lost to follow-up.
  
  
  RESULTS
  At 1 week after surgery, compared to preoperative baseline, we found reduced hemoglobin A1c (7.63 to 7.31, P < 0.001), insulin (24.96 to 10.92, P < 0.05), and borderline significant homeostatic model assessment insulin resistance (HOMA-IR, 9.48 to 3.91, P > 0.05). Low-density lipoprotein (LDL) cholesterol increased and high-density lipoprotein (HDL) cholesterol decreased. Three months after surgery, hemoglobin A1c, insulin, and HOMA-IR continued to decrease (6.05, 7.11, and 1.92, respectively, P < 0.05), with hemoglobin A1c correlated to weight loss (P < 0.05). Triglycerides, triglyceride to HDL ratio, and total cholesterol to HDL ratio also decreased, but there was no significant change in LDL cholesterol or HDL versus presurgery levels. Reduced triglyceride levels were correlated with reduced alanine transaminase (ALT) and gamma-glutamyl transpeptidase (GGT) (P < 0.05).
  
  
  CONCLUSIONS
  LSG is associated with marked antidiabetic effects as early as 1 week after surgery, unrelated to weight loss. The antidiabetic effect improves at 3 months. Triglyceride reduction was associated with improved hepatic functions, but cholesterol did not show a meaningful reduction.
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Chanan
authors.identifier: http://orcid.org/0000-0002-8824-6309
authors.initials: C
authors.lastname: Meydan
authors.affiliation: Felsentein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Goldstein
authors.affiliation: Felsentein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Efrat
authors.initials: E
authors.lastname: Weiss-Shwartz
authors.affiliation: Felsentein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Lederfine
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Goitein
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel. m_rubin@netvision.net.il.|Felsentein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel. m_rubin@netvision.net.il.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. m_rubin@netvision.net.il.
authors.forename: Moshe
authors.initials: M
authors.lastname: Rubin
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., Tel Hashomer, 56261, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Hadar
authors.initials: H
authors.lastname: Spivak
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008297:Male; D009767:Obesity, Morbid / Q000378:metabolism* / Q000601:surgery*; D011184:Postoperative Period; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; D007328:Insulin; D008055:Lipids; D014280:Triglycerides
keywords: Dyslipidemia; Insulin resistance; Obesity; Sleeve gastrectomy; Type 2 diabetes mellitus