Metabolic efficacy following laparoscopic sleeve gastrectomy with loop duodenal switch surgery for type 2 diabetes in Indian patients with severe obesity

Background and aims: Metabolic surgery improves glycemic control in patients with type 2 diabetes (T2DM) and severe obesity. Sleeve gastrectomy with loop duodenal switch (SLDS), a loop modification of biliopancreatic diversion with duodenal switch, is aimed to reduce the malabsorption, without compromising the efficacy. This study was designed to analyze the metabolic efficacy following SLDS. Methods: Eighty patients, who underwent SLDS for T2DM and severe obesity between January 2014 and February 2020 were retrospectively analyzed. Complete T2DM remission was defined as HbA1C < 6% in the absence of anti-diabetic medications. T2DM remission was analyzed at the 6-month and 1-year follow-ups in terms of various predictors. Prediction of T2DM remission by ABCD, DiaRem and IMS scores was analyzed. Lower ABCD scores and higher DiaRem and IMS scores indicate severe T2DM. Results: Following SLDS, HbA1C significantly reduced from 8.7% to 5.5% at the 6-month and 5.1% at the 1 year follow-ups. T2DM remission was 82.5% at the 6-month and 90.8% at the 1-year follow-ups. Preoperative glycemic control positively predicted, while T2DM duration and preoperative insulin use negatively predicted T2DM remission. Higher ABCD score, lower DiaRem and IMS scores predicted higher T2DM remission. Severe hypoalbuminemia was 20% in patients with 250 cm common channel and 02% in patients with >300 cm common channel at the 1-year follow-up. Conclusions: SLDS is an effective surgery to treat T2DM with severe obesity. Shorter T2DM duration, better preoperative glycemic control and the absence of insulin use were associated with better T2DM remission. Malabsorption was significantly lesser, when common channel was >300 versus 250 cm. (C) 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.