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Article 5 SLEEVE GASTRECTOMY AND TYPE 2 DIABETES MELLITUS: A SYSTEMATIC REVIEW CITATION Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6:707–713. PURPOSE OF THE STUDY The purpose of the systematic review is to assess the efficacy of laparoscopic sleeve gastrectomy (LSG) on weight loss and in resolving type 2 diabetes mellitus (T2DM) in patients with obesity. METHODS A search for studies was performed using electronic databases such as MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, BIOSIS Previews, TRIP, Health Technology Database, conference abstracts, clinical trials, and the Cochrane Library database. All human studies reported from 2000 to April 2010 were considered for inclusion in this review. Studies included were human retrospective and prospective case series, nonrandomized, controlled trials, and randomized controlled trials. A total of 3,621 studies were identified and 3,332 were rejected. Of the remaining 289 studies, 27 studies meet the inclusion criteria for this review. These studies include 3 nonrandomized, prospective, controlled trials, 3 retrospective, controlled trials, 15 prospective case series, and 6 retrospective case series. This review includes studies of adult patients (>18 years old) who have a diagnosis of T2DM, are considered clinically obese with a BMI >30kg/m2 their patients. Secondary outcomes: • Eleven included studies reported significant excess weight loss of 47.3±19.1%. • Mean preoperative BMI based on 13 studies was 47.4±7.9kg/m2 . • Based on 8 included studies, postoperative BMI decreased to 35.9±6.6kg/m2 . , and have undergone LSG. The primary outcome measured is resolution of T2DM. The secondary outcomes measured were percentage of excess weight loss, change in BMI, and change in glucose levels, HbA1c levels, mortality, and postoperative complications. RESULTS Twenty-seven studies assessing 673 patients were included in this review. Patients had a mean follow up of 13.1±8.1 months. Primary outcome: • Based on 26 studies, the T2DM resolution rate was 66.2%: 16 studies reported both resolution and improvement of T2DM, with 97.1% of patients experiencing resolution or improvement of T2DM; and four studies reported T2DM resolution, improvement, or stability of disease in 94.8% of • Plasma glucose levels decreased from a baseline 181.2mg/dL to 119.2mg/dL, based on 7 studies reporting plasma glucose results. • Within the 11 studies reporting HbA1c levels, the levels decreased from a baseline of 7.9% to 6.2%. • The operative mortality rate at ≤30 days was 0.36% for all LSG procedures, based on 16 studies. • The rate for postoperative complications, such as bleeding, was 1.79%. • The postoperative abscess or infection rate was 0.27%. • The postoperative leak rate was 1.97%. CONCLUSION Based on the data collected from these studies, LSG has a substantial effect on morbid obesity and T2DM by providing improvement or resolution in most cases. 12S Bariatric Times • June 2012 • Supplement