Clinical Topics   /   Endocrinology

Surgery Means Better Glucose Control for Veterans

USM By U.S. Medicine
August 5, 2014

BRONX, NY – Laparoscopic sleeve gastrectomy produced better blood glucose control for veterans after two years than standard diabetes medical care without weight loss surgery, according to a new study.

The research, presented recently at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago, also found that 76% of surgery patients were able to reduce their use of diabetes medications, compared with only 26% of patients in the non-surgical group.1

“Individuals with obesity now have another treatment option that can help reduce weight and manage diabetes,” said the study’s principal investigator, Pietra Greenberg, MD, an endocrinologist at James J. Peters VAMC in Bronx, NY.

Sleeve gastrectomy is a minimally invasive technique for making the stomach smaller, and several studies have found the procedure is effective for weight loss. Few studies have been conducted, however, on diabetes outcomes in patients who underwent the surgical procedure compared with those of nonsurgically treated patients with diabetes, according to Greenberg.

For the study, researchers compared the medical records from 2010 to 2014 of 53 veterans with type 2 diabetes: 30 patients who underwent sleeve gastrectomy and 23 who received medical diabetes care but did not receive any weight loss surgery. The study participants, nearly all men, ranged from 29 to 80 years old and had diabetes for an average of 10 years.

Nonsurgical control subjects lost no weight on average over a two-year follow-up period and, as a result, did not reduce their body mass index (BMI). In the sleeve gastrectomy group, however, BMI decreased from 41 kg/m2, defined as morbidly obese, to 34 kg/m2 two years after surgery.

Hemoglobin A1c, meanwhile, fell from an average of 7.25 percent before sleeve gastrectomy (but after lifestyle changes such as diet and exercise) to 5.98% following surgery. No significant change was documented in the control group.

Most of the patients who underwent sleeve gastrectomy also were able to discontinue some diabetes medications, such as insulin, because of their weight loss, according to the study results. No changes were seen in total cholesterol or LDL cholesterol for surgery patients.

“This research highlights the benefits of a surgical approach such as sleeve gastrectomy to help improve diabetes outcomes, especially compared to more conservative medical management,” Greenberg commented.

Improvement in diabetes measures in the surgical group reached a plateau at the end of two years, however.

“Surgery may not be a permanent solution to improving diabetes control. However the procedure does have immediate benefits that appear to set the patient on a path to a healthier future,” she added.

“It is interesting to note that sleeve gastrectomy may offer better diabetes control and improved outcomes compared to patients who follow medical care only,” the authors pointed out. “However, the improvement in outcomes in surgery patients may not be a permanent solution for diabetes outcomes.”

1 Malhotra S, Gupta N, Galiveeti S, Milekic B, Greenberg PD. Sleeve Gastrectomy Outcomes in Veterans with Type II Diabetes. International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014, June 23, 2014, in Chicago


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