The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI <35 kg/m2

Abstract

Aims/hypothesis To aim of the study was to investigate the effect of bilio-pancreatic diversion (BPD) on type 2 diabetes in patients with BMI <35 kg/m 2 . Methods OGTTs were performed and anthropometric data were compared between five diabetes patients (BMI 27-33 kg/m 2 ) following BPD and seven diabetes patients after a low-energy diet. Insulin secretion was computed by C-peptide deconvolution. A euglycaemic-hyperinsulinaemic clamp was performed only in the BPD group and the M value measured. Results One month after BPD, fasting and 2 h post-OGTT glycaemia decreased from 15.22±3.22 to 6.22± 0.51 mmol/l (p=0.043), while insulin sensitivity increased significantly. No significant changes were observed in the low-energy diet group. Insulin secretion did not differ significantly after either intervention. Diabetes amelioration (change in HbA 1c level) was observed up to 18 months after BPD without pharmacological therapy. Conclusions/interpretation BPD can achieve adequate control of type 2 diabetes also in patients with BMI <35 kg/m 2 . The rapid postoperative remission of diabetes is primarily related to an improvement in insulin sensitivity.

Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

“…The rapid postoperative remission of T2DM is primarily related to an improvement in insulin resistance rather than increasing insulin secretion. 25,26 The difference in insulin resistance in the postoperative period between the 2 procedures found in this meta-analysis also supports the theory that duodenum exclusion is helpful for the reduction of insulin resistance. In recent studies, Korner and colleagues 27 found that reduction of insulin resistance correlated significantly with weight loss only in patients who underwnt gastric banding, not in those who had gastric bypass, and Bikman and colleagues 28 found that improved insulin sensitivity after gastric bypass was due to something other than weight loss.…”

Biliopancreatic Diversion in Nonobese Patients With Type 2 Diabetes: Impact and Mechanisms

“…In very obese T2D patients (BMI Ն 35 kg/m 2 ), BPD is followed by rapid normalization of insulin sensitivity and improved ␤-cell function (11)(12)(13)(14). In T2D patients with a BMI less than 35 kg/m 2 , an early trial of 5 subjects (25) showed achievement of good glycemic control 1 month after surgery, and a larger study of 30 patients followed up for up to 2 years (26) suggested differences in outcome, depending on initial BMI. In the present series of well-characterized patients with long-standing T2D and BMI less than 30 kg/ m 2 , we assessed remission at 1 year by stringent criteria and carried out detailed investigations of insulin sensitivity and ␤-cell function [combining oral glucose tolerance test (OGTT), mixed meal, and euglycemic insulin clamp with tracer glucose] before, 2 months, and 1 year after BPD in comparison with gender-, age-, and BMI-matched nondiabetic controls.…”

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 RYGB

“…No excessive weight loss occurred. After 1 year, the mean BMI values and the minimum and maximum values of BMI were 23 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28), 27 (24)(25)(26)(27)(28)(29)(30), and 27 (26-28) kg/m 2 for the BPD-DS group, BPD group and RYGB group, respectively. The differences between the groups did not reach significance.…”