Impact of Laparoscopic Sleeve Gastrectomy on Obese Type 2 Diabetic Patients and Role of Gut Hormones Peptide Tyrosine Tyrosine and Glucagon Like Peptide 1on Remission of Diabetes
Heba H. Zayed *
Department of Internal Medicine, Faculty of Medicine, Tanta University, Egypt.
Karim Sabry
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt.
Yasser M Abdelraouf
Department of Internal Medicine, Faculty of Medicine, Tanta University, Egypt.
Wessam M. Salah
Department of Clinical Pathology, Faculty of Medicine, Tanta University, Egypt.
Ingy Abdel Wahab
Department of Internal Medicine, Faculty of Medicine, Tanta University, Egypt.
Mabrouk R EL- Sheikh
Department of Internal Medicine, Faculty of Medicine, Tanta University, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Our Study Aimed: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on obese T2DM patients, its effect in remission of diabetes and role of gastrointestinal Glucagon like peptide 1(GLP1) and Peptide tyrosine tyrosine (PYY) hormones. Metabolic surgery should be recommended as an option in type 2 diabetic patients (T2DM) with body mass index (BMI) ≥40 Kg/m2, in patients who have BMI ≥35 Kg/m2 and in selected patients with BMI < 35 Kg/m2, if not achieving diabetes control with maximum tolerated anti-hyperglycemic treatment.
Methods: 30 T2DM patients with BMI ≥ 40 kg/m2 underwent laparoscopic sleeve gastrectomy after full clinical evaluation, routine blood tests, glucagon like peptide 1, Peptide tyrosine tyrosine (fasting, 0.5-hour post-mixed meal test (MMT) serum levels) and upper GIT endoscopy. Follow-up visits were at 3, 6 and 9 months postoperatively to evaluate body weight, BMI and glycated hemoglobin (HbA1C) and at 18th month for confirmation of diabetes remission. Gut hormones were measured at 15 days and 9 months postoperatively.
Results: (53.3%) of patients had partial remission of T2DM according to HbA1C remission criteria. There was significant increase in fasting and post-MMT levels of peptide tyrosine tyrosine, glucagon like peptide 1 postoperatively. The only independent predictors for remission of T2DM were the baseline serum low density lipoprotein cholesterol (LDL-Ch), duration of diabetes, preoperative post MMT Peptide tyrosine tyrosine plasma level, serum thyroid stimulating hormone (TSH) and age.
Conclusions: laparoscopic sleeve gastrectomy can induce partial remission of diabetes in younger patients who had shorter duration of diabetes, higher level of preoperative post-MMT peptide tyrosine tyrosine, lower levels of preoperative serum LDL-Ch and thyroid stimulating hormone.
Keywords: Laparoscopic sleeve gastrectomy, glucagon like peptide 1, peptide tyrosine tyrosine, Mixed Meal Test (MMT).