Metabolic Intestinal Bypass Surgery for Type 2 Diabetes in Patients with a BMI < 35 kg/m2: Comparative Analysis of 16 Patients Undergoing either BPD, BPD-DS, or RYGBFrenken M. · Cho E.-Y.
Department of Surgery, St. Josef Krankenhaus Monheim, Germany
Background: Metabolic surgery for type 2 diabetes mellitus in patients with low body mass index (BMI) is a novel concept. Early studies show the surgery to be safe and effective but are inconclusive regarding the most effective procedure. Methods: Metabolic intestinal bypass surgery was performed in n = 16 patients with type 2 diabetes and a BMI < 35 kg/m2 (mean age 56 years, range 36–68; 8 females; mean BMI 32 kg /m2, range 26–34.5). Biliopancreatic diversion with duodenal switch (BPD-DS), biliopancreatic diversion according to Scopinaro (BPD), and Roux-en-Y gastric bypass (RYGB) were performed in 7, 5, and 4 diabetic patients, respectively. Mean preoperative duration of medical antidiabetic therapy was 16 years (range 4–40). Thirteen patients used insulin on average for 6 years (range 1–12), the mean insulin requirement was 92 IU per day (range 30–140). The analysis was accomplished retrospectively from data prospectively collected in our data base. Results: At discharge from hospital, only 3 of the 13 patients who used insulin preoperatively required small amounts of insulin (mean 21 IU per day, range 15–30) to keep fasting and postprandial plasma glucose levels below 200 mg/dl. After 1 year, none of the patients used insulin or oral antidiabetic drugs. The HbA1c level decreased for the total patient population from 8.6% (range 5.8–12.1) preoperatively to 6.0% (range 4.3–7.8), 5.7% (range 4.1–7.6), and 5.6% (range 4.1–7.8) after 3, 6, and 12 months, respectively. The HbA1c levels at 1 year were significantly lower after BPD-DS and BPD than after RYGB (5.2%, range 4.1–6.4 versus 6.7%, range 5.8–7.8, p < 0.01, DHbA1c 1.4%, 95% confidence interval 0.5–2.4). Conclusion: Metabolic intestinal bypass surgery for type 2 diabetes in low BMI patients is effective, with HbA1c levels at 1 year after the operation being significantly lower after BPD-DS or BPD than after RYGB.
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