Zhangxuan Xu,1,* Weihao Zhang,2,* Shunli Chen,3 Bin Liu,1 Yuqin Sun3 

1Department of Gastrointestinal Surgery, Anqing First People’s Hospital Affiliated to Anhui Medical University, Anqing, Anhui, 246000, People’s Republic of China; 2Department of General Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, 361001, People’s Republic of China; 3Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Bin Liu, Email beanleu2@163.com Yuqin Sun, Email sunyuqin0212@163.com

Objective: This retrospective cohort study identified predictors of treatment efficacy for modified three-port laparoscopic sleeve gastrectomy (TPLSG) in managing type 2 diabetes mellitus (T2DM).
Methods: We retrospectively analyzed clinical data from 187 T2DM patients who underwent modified TPLSG. Patients were categorized into effective group (those with satisfactory weight loss and diabetes remission/improvement) and ineffective group [those with insufficient weight loss and/or inadequate glycemic control (including patients meeting either or both criteria)]. After comparing baseline characteristics between groups, we performed Logistic regression analysis on significantly different variables to identify factors influencing treatment outcomes. A predictive nomogram was constructed and validated using calibration curves to assess the clinical value of these factors in predicting TPLSG efficacy for T2DM.
Results: This study conducted a total inclusion of 187 T2DM patients who were grouped according to whether they performed effective or ineffective after treatment with modified TPLSG. 131 were included in the effective group and 56 in the other group. In respects of baseline C-peptide level, duration of diabetes, baseline triacylglycerol (TG) level, baseline homeostasis model assessment of insulin resistance (HOMA-IR) and baseline glycated hemoglobin (HbAlc) levels, the two groups displayed statistical significance (P < 0.05). Covariance analysis and Logistic regression equations for above factors revealed that none of them were covariate (VIF ≤ 10, tolerance ≥ 0.1) and all of them were influential factors leading to poor treatment effect after modified TPLSG, it was found that the mentioned factors boasted high application value in predicting the efficacy of patients after modified TPLSG by nomogram and calibration curves.
Conclusion: Baseline C-peptide level, duration of diabetes, baseline TG, baseline HOMA-IR, and baseline HbAlc level were all relevant factors affecting the treatment effect of patients with T2DM treated with modified TPLSG, which should be focused on and interfered in a targeted way in actual clinical practice.

Keywords: modified three-port laparoscopic sleeve gastrectomy, TPLSG, type 2 diabetes mellitus, C-peptide levels, insulin resistance index