title: Impact of Sleeve Gastrectomy on Type 2 Diabetes Mellitus, Gastric Emptying Time, Glucagon-Like Peptide 1 (GLP-1), Ghrelin and Leptin in Non-morbidly Obese Subjects with BMI 30-35.0 kg/m2: a Prospective Study.
abstract: The study was conducted to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) of 30.0-35.0 kg/m2. Possible mechanisms, including alterations in gastric emptying time (GET), glucagon-like peptide 1 (GLP-1), ghrelin and leptin, were evaluated.
  
  
  
  Twenty obese patients with T2DM and with a BMI of 30.0-35.0 kg/m2underwent LSG during March 2012 to February 2015. Glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG) and GET were measured at baseline, 3 months, 6 months, 12 months and 24 months after surgery. Fasting and post-prandial levels of serum GLP-1, ghrelin and leptin were measured pre-operatively and after 3 and 6 months.
  
  
  
  The average duration of follow-up was 17.6 months, and 10 patients had completed 2 years of follow-up. After 2 years, the average BMI decreased from 33.4 ± 1.2 to 26.7 ± 1.8 kg/m2. The mean HbA1c decreased from 8.7 ± 1.6 to 6.7 ± 1.5 %, respectively. Ten patients achieved complete remission. Insulin could be stopped in all six patients who were on it pre-operatively. Meal-stimulated GLP-1 response and serum insulin at 30 min showed a significant increase following surgery. There was a significant decrease in GET.
  
  
  
  This prospective study confirms the positive impact of LSG on diabetic status of non-morbidly obese patients. The possible mechanisms include the rise in post-prandial GLP-1 level induced by accelerated gastric emptying, leading to an increase in insulin secretion. LSG also leads to decreased ghrelin and leptin levels which may have a role in improving glucose homeostasis after surgery.
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
authors.forename: B
authors.initials: B
authors.lastname: Vigneshwaran
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
authors.forename: Akshat
authors.initials: A
authors.lastname: Wahal
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India. sandeep_aiims@yahoo.co.in.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
authors.forename: Pratyusha
authors.initials: P
authors.lastname: Priyadarshini
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
authors.forename: Hemanga
authors.initials: H
authors.lastname: Bhattacharjee
authors.affiliation: Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khadgawat
authors.affiliation: Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Yadav
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005746:Gastric Emptying / Q000502:physiology*; D054439:Ghrelin / Q000097:blood*; D052216:Glucagon-Like Peptide 1 / Q000097:blood*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D010535:Laparoscopy / Q000379:methods; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D054439:Ghrelin; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007328:Insulin; D020738:Leptin
keywords: Class 1 obesity; Diabetes mellitus; Gastric emptying time; Glucagon-like peptide 1; Mechanisms; Sleeve gastrectomy