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

Abstract

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.

Alternative ways to correct poor glucose metabolism in patient with diabetes mellitus

“…The procedure was called the ileal transposition, and for the first time, there was a decrease in the amount of food consumed, body weight, glucose, triglycerides, and cholesterol levels with a preserved length of the small intestine [8]. Some clinical studies combined the ileal transposition with gastric bypass surgery or sleeve gastrectomy [33][34][35][36]. During a study of the metabolic effects of the ileal transposition in combination with elevating sleeve gastrectomy (DSG) in 159 patients with obesity and DM2, Celik et al found a decrease in the average body mass index (BMI) from 39.33 to 25.51, the average fasting glucose level from 189.9 to 123.5 mg/dL, and the average HbA1c level from 9.24% to 6.14% a year after surgery [31].…”

Surgical correction of metabolic syndromes in rats: methodological aspects

“…Редкой причиной смерти животных в послеоперационном периоде может быть ýвентрациявыпадение органов брюшной полости через дефект передней брюшной стенки, обусловленный несостоятельностью хирургического шва послеоперационной раны [37,41]. В случае ýвентрации животное нуждается в ýкстренной операции.…”