OR40-4 Sleeve Gastrectomy Outcomes in Veterans with Type II Diabetes

Program: Abstracts - Orals, Poster Preview Presentations, and Posters
Session: OR40-Type 2 Diabetes: Beta Cell Function and Novel Interventions
Monday, June 23, 2014: 11:30 AM-1:00 PM
Presentation Start Time: 12:15 PM
W185 (McCormick Place West Building)

ISE Travel Grant
Sheetal Malhotra, MD, MS1, Namita Gupta, MD2, Sneha Galiveeti, MD1, Bojana Milekic, MD1 and Pietra Dale Greenberg, MD3
1JJ Peters VA Medical Center, Bronx, NY, 2University of Nebraska Medical Center, Omaha, NE, 3James J Peters VA Med Ctr, Bronx, NY
The link between obesity and type 2 diabetes is clearly established with weight loss resulting in improvement in insulin sensitivity and glycemic control.  Laparoscopic sleeve gastrectomy involves the removal of the greater curvature of the stomach, and is now a common low-morbidity surgical technique for weight loss. Previous cohort studies have shown improvement in obesity in patients undergoing sleeve gastrectomy. However, there have been no studies comparing long term diabetes outcomes in patients undergoing surgical intervention as compared to controls who are on nonsurgical diabetes care. 

Research question: To compare long term diabetes outcomes in patients undergoing sleeve gastrectomy as compared to controls who undergo nonsurgical diabetes care.

Methods: We reviewed medical records of veterans between 18 and 80 years of age with type 2 diabetes undergoing sleeve gastrectomy at a VA medical center in a major metropolitan area.  Primary study outcomes included measures of diabetes control including HbA1C and BMI. Secondary outcomes such as total and LDL cholesterol, hospitalizations and mortality were also assessed. Data from surgery patients were compared to data from diabetic controls that did not undergo surgery using  descriptive analyses, t-tests , and repeated measures ANOVA.

Results: Data from charts of 30 surgery patients and 23 controls were analyzed from 2010 to 2013.  Most of the subjects enrolled were males (96%) with an average age of 57 years (range 29-80 years) .  The median BMI at baseline was 41 (range 36-60) kg/m2 and median Hba1c was 7.3.  There was a significant improvement in BMI and Hba1c in surgery patients over one year follow up; improvements were sustained through the end of two years after surgery. Mean BMI decreased from 41 to 34 over two years ( P<0.001) and mean Hba1c decreased from 7.25 to 5.98 (P<0.001).  Similar outcomes were not seen in controls during the study period. Differences in these outcomes between surgery patients and controls were significant over short term and long term follow up (P<0.001).   No changes were seen in total cholesterol or LDL cholesterol for surgery patients.  However, it was noted that the changes in outcomes plateau after the first year of surgery.

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

Conclusion: Sleeve gastrectomy is effective in improving diabetes outcomes in veterans as compared to those receiving nonsurgical diabetes care.

Nothing to Disclose: SM, NG, SG, BM, PDG

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