Impact on Dyslipidemia of the Laparoscopic Ileal Interposition Associated to Sleeve Gastrectomy in Type 2 Diabetic Patients

DePaula, Aureo L.; Stival, Alessandro R.; DePaula, Carolina C. L.; Halpern, Alfredo; Vencio, Sérgio

doi:10.1007/s11605-010-1252-5

Cited by 24 publications

(7 citation statements)

References 29 publications

(17 reference statements)

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“…4, 5 Even performing a duodenal-jejunal bypass in non-obese patients with type 2 diabetes (T2D) leads to disease remission in a majority of patients. 6, 7 Information on factors to predict an improvement in insulin sensitivity would provide biomarkers and contribute to understanding the mechanisms involved.…”

Section: Introductionmentioning

confidence: 99%

Acylation stimulating protein reduction precedes insulin sensitization after BPD-DS bariatric surgery in severely obese women

et al. 2012

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Objective:The mechanisms involved in early resolution of insulin resistance and type 2 diabetes mellitus after biliopancreatic diversion with duodenal switch (BPD-DS) surgery are still unknown. We evaluated early effects of BPD-DS on plasma acylation stimulating protein (ASP), an adipokine involved in lipid and glucose metabolism.Subjects:32 non-diabetic and 22 diabetic severely obese women (BMI⩾40 kg m−2) were evaluated for body composition and plasma parameters before, 24 h, 5 days, 6 and 12 months after surgery.Results:Within the early postoperative period (24 h), ASP decreased 25 and 30% in non-diabetic and diabetic women, respectively (P<0.001). Twenty-four hours after surgery, triglyceride, cholesterol, HDL-Chol, LDL-Chol and C3 also decreased, while glucose, insulin and high-sensitivity C-reactive protein (hsCRP) increased (all P<0.001). By 5 days, without significant weight loss, the decreases in ASP, cholesterol, HDL-Chol and LDL-Chol levels were all maintained. At this time, glucose, insulin and HOMA-IR also decreased 11 to 52% (all P<0.001). At 6 and 12 months, with pronounced weight loss and decreased per cent fat mass, there were further decreases in ASP (maximal −56% non-diabetic, −61% diabetic, P<0.001), as well as in glucose, insulin, HOMA-IR, triglyceride, cholesterol, LDL-Chol, HDL-Chol and hsCRP levels. Improved insulin resistance/diabetes at 5 days was predicted by 24 h changes as follows: per cent change ASP, HDL-Chol, hsCRP and total cholesterol predicted HOMA-IR (5 days) (r2=0.454, P<0.001), and per cent change ASP, HDL-Chol and hsCRP predicted change (5 days vs baseline) in HOMA-IR (r2=0.351, P<0.001).Conclusion:Acute postoperative decreases in ASP are associated with early improvement of insulin resistance/diabetes after BPD-DS surgery.

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Section: Introductionmentioning

confidence: 99%

Acylation stimulating protein reduction precedes insulin sensitization after BPD-DS bariatric surgery in severely obese women

et al. 2012

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“…Other reports of DSIT performed on non-morbidly obese type 2 diabetic patients with a mean 39.1 (25–61) months follow up confirmed the beneficial effects and marked remission in diabetes, weight control, hypertension and dyslipidemia (DePaula et al 2012 ). These effects have been documented in other publications and its effects on lipid metabolism have been particularly associated with the change in bilio-enteric circulation (Yang et al 2013 ; DePaula et al 2010 ). Similarly, beneficial effects on glycemia have been attributed to the improvement in insulin sensitivity and beta cell function confirmed by prospective studies (Vencio et al 2011 ).…”

Section: Discussionmentioning

confidence: 60%

The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs

Çelik¹,

Asci²,

Celik³

et al. 2015

SpringerPlus

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BackgroundType 2 diabetes mellitus (T2DM) has gained pandemic proportions becoming a global threat within the last few decades. In parallel to the increasing prevalence, healthcare costs have become a huge economic burden for the hospital and governments. Bariatric surgery has been proven to induce glycemic control in obese type 2 diabetics. However, the cost effectiveness of metabolic surgery in overweight, obese and morbidly obese individuals has not been documented. We aimed to demonstrate the efficacy and reduced diabetic-medication cost after diverted sleeve gastrectomy with ileal interposition (DSIT) in type 2 diabetic individuals followed more than 1 year.MethodsRecords of 116 type 2 diabetic patients operated by DSIT at a dedicated metabolic surgery clinic between October 2011 and April 2013 were retrospectively reviewed. A comparison was made between the annual diabetic medication cost before and after surgery using the paired t test. The alterations in BMI and HbA1c were recorded and analyzed.ResultsDiverted sleeve gastrectomy with ileal interposition led to a marked reduction in BMI and improved glycemic control after 1 year follow-up. Mean HbA1c levels decreased from a mean of 8.9 ± 1.7 to 6.6 ± 1.1 1 year after surgery (p < 0.001). Mean preoperative BMI declined from 32.9 ± 4.3 to 24.7 ± 2.7 kg/m2 (p < 0.001). Cost of diabetic medication decreased from a mean 660.08 USD/year to 65.12 USD 1 year after surgery (p < 0.001).ConclusionOur results have shown that DSIT operation leads to a significantly better glycemic control and lower diabetic medication costs at 1 year.

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“…De Paula et al first performed laparoscopic sleeve gastrectomy with ileal interposition (Fig. 1) in patients with BMI \30 kg/m 2 and found that 86.1% of patients had HbA1C \7% after a mean follow-up period of 24 months [13,14]. The same authors compared ileal transposition with laparoscopic sleeve gastrectomy and ileal transposition with diverted laparoscopic sleeve gastrectomy and found that both operations reduced HbA1C levels, with the latter surgery trending towards lower HbA1C [15].…”

Section: Epidemiological Trends Of Diabetesmentioning

confidence: 99%

Diabetic and bariatric surgery: A review of the recent trends

Rao

Kini

2011

Surg Endosc

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RYGB and biliopancreatic diversion (BPD) are effective surgical options for diabetes in the long term (>5 yrs). The efficacy of sleeve gastrectomy on diabetes in the long term is not yet known. Gastrointestinal procedures for non morbidly obese and non obese patients have shown great promise as surgical optional for diabetes, though their efficacy and safety in the long term are unknown. Novel endoscopic techniques and TANTALUS have shown some promise in resolving diabetes in obese patients. Bariatric surgery is very effective is resolving adolescent diabetes.

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Impact on Dyslipidemia of the Laparoscopic Ileal Interposition Associated to Sleeve Gastrectomy in Type 2 Diabetic Patients

Abstract: The laparoscopic ileal interposition associated to sleeve gastrectomy was an effective operation for the regression of dyslipidemia and T2DM in a non-obese population.

Cited by 24 publications

References 29 publications

Acylation stimulating protein reduction precedes insulin sensitization after BPD-DS bariatric surgery in severely obese women

Acylation stimulating protein reduction precedes insulin sensitization after BPD-DS bariatric surgery in severely obese women

The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs

Diabetic and bariatric surgery: A review of the recent trends

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