title: Time to Glycemic Control - an Observational Study of 3 Different Operations.
abstract: Medical treatment fails to provide adequate control for many obese patients with type 2 diabetes mellitus (T2DM). A comparative observational study of bariatric procedures was performed to investigate the time at which patients achieve glycemic control within the first 30 postoperative days following sleeve gastrectomy (SG), mini-gastric bypass (MGB), and diverted sleeve gastrectomy with ileal transposition (DSIT).
  
  
  
  Included patients had a body mass index (BMI) ≥30 kg/m2; T2DM for ≥3 years, HbA1C> 7 % for ≥3 months, and no significant weight change (>3 %) within the prior 3 months. Surgical procedures performed were SG (n = 49), MGB (n = 93), and DSIT (n = 109). The primary endpoint was the day within the first postoperative month on which mean fasting capillary glucose levels reached <126 mg/dL. Multivariate logistic regression analysis was used to identify predictors of glycemic control.
  
  
  
  The cohort included 251 patients with a mean BMI of 36.04 ± 5.76 kg/m2; age, 52.84 ± 8.52 years; T2DM duration, 13.09 ± 7.54 years; HbA1C, 8.82 ± 1.58 %. On the morning of surgery, mean fasting plasma glucose was 177.63 ± 51.3 mg/dL; on day 30, 131.35 ± 28.7 mg/dL (p < 0.05). Mean fasting plasma glucose of <126 mg/dL was reached in the DSIT group (124.36 ± 20.21 mg/dL) on day 29, and in the MGB group (123.61 ± 22.51 mg/dL), on day 30. The SG group did not achieve target mean capillary glucose level within postoperative 30 days.
  
  
  
  During the first postoperative month, glycemic control (<126 mg/dL) was achieved following DSIT and MGB, but not SG. Preoperative BMI and postprandial C-peptide levels were independent predictors of early glycemic control following DSIT.
authors: Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Hastanesi Sok., Kent Pasaji, Kat: 1-2, Sisli, Istanbul, Turkey. doktoralper@hotmail.com.
authors: Alper
authors: 0000-0003-2084-5871
authors: A
authors: Celik
authors: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors: Sjaak
authors: S
authors: Pouwels
authors: Department of Endocrinology, GATA Haydarpaşa Training & Research Hospital, Istanbul, Turkey.
authors: Fatih Can
authors: FC
authors: Karaca
authors: Department of Endocrinology, GATA Haydarpaşa Training & Research Hospital, Istanbul, Turkey.
authors: Eylem
authors: E
authors: Çağıltay
authors: Kirloskar Hospital, Bariatric & Metabolic Surgery Clinic, Hyderabad, India.
authors: Surendra
authors: S
authors: Ugale
authors: Faculty of Medicine Department of Biostatistics, Near East University, Nicosia, Cyprus.
authors: İlker
authors: İ
authors: Etikan
authors: Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Hastanesi Sok., Kent Pasaji, Kat: 1-2, Sisli, Istanbul, Turkey.
authors: Deniz
authors: D
authors: Büyükbozkırlı
authors: Metabolic Surgery Clinic, Halaskargazi Cad. Etfal Hastanesi Sok., Kent Pasaji, Kat: 1-2, Sisli, Istanbul, Turkey.
authors: Yunus Emre
authors: YE
authors: Kılıç
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose; D002096:C-Peptide
keywords: Bariatric surgery; Diverted sleeve gastrectomy with ileal transposition; Glycemic control; Mini-gastric bypass; Sleeve gastrectomy