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Modified bariatric surgery led to remission of type 2 diabetes, metabolic syndrome

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HOUSTON — Patients who underwent ileal interposition with sleeve gastrectomy/diverted sleeve gastrectomy were able to reverse their type 2 diabetes and associated metabolic syndrome, particularly when the duration of their diabetes was less than 10 years, data presented here demonstrate.

“Surgery is a novel way to address obesity and type 2 diabetes. It promises a high cure rate,” Kirtikumar Modi, MD, an endocrinologist at Medwin Hospital in Hyderabad, India said during a presentation.

The study included 43 patients (25 men, 18 women) who underwent ileal interposition plus sleeve gastrectomy (II+SG). Those with type 2 diabetes for more than 1 year and were aged 25 to 70 years, with stable weight for 3 months and stimulated C-peptide level >1.5 ng/mL, were included.

According to data, another 17 patients (12 men, 5 women) underwent IIS/Diverted Sleeve Gastrectomy (II+DSG) based on adverse characteristics, like longer duration of diabetes, lower BMI and poorer C-peptide response.

The remission of diabetes was defined as having an HbA1c <6.5% without the assistance of oral hypoglycemic agents (OHA) or insulin, and was the primary outcome of the study. The secondary outcome was reduction in OHA requirement and improved metabolic profile. Patients participated in follow-up at three monthly intervals, Modi said.

II+SG

Researchers found that patients who underwent II+SG had an average age of 47.2 years, with diabetes duration of 10.1 years and BMI of 33.2.

Of this group, all patients had poor glycemic control with an HbA1c of -9.6%. Additionally, 30 patients (70%) had hypertension, 20 patients (45%) had dyslipidemia and 18 (42%) had microalbuminuria.

The average follow-up was 4 to 40 months, with evidence of post-operative glycemic parameters improving at all intervals (P<.05).

Data showed that 20 patients (47%) experienced remission in type 2 diabetes, and 27 patients (90%) had remission in hypertension. Moreover, there was a decline in lipids and microalbuminuria, as well as a decrease in OHA requirement.

II+DSG

Patients who underwent II+DSG were aged 50.7 years, with diabetes duration of 15.1 years and BMI of 29.2.

Of those patients, eight (45%) had hypertension, seven (39%) had dyslipidemia and seven (39%) had microalbuminuria.

The mean follow-up data was collected over a 3- to 21-month range, where researchers found 12 (70.5%) patients experienced diabetes remission, with the remaining five demonstrating significant decreases in OHA requirement. Additionally, seven patients (87.5%) had remission of hypertension.

At all intervals of the follow-up, these patients experienced significant decline in glycemic, lipid parameters and microalbuminuria (P<.05).

“Modified bariatric surgery promises to be an effective treatment for achieving a cure of type 2 diabetes and other metabolic abnormalities like high blood pressure,” Modi said.

Modi concluded that patients who underwent either II+SG/DSG controlled their type 2 diabetes and the condition’s associated metabolic syndrome. – by Samantha Costa

For more information:

Kota S. Abstract #OR40-1. Presented at: the Endocrine Society’s 94th Annual Meeting & Expo. June 23-26, 2012; Houston.

Disclosure:  The researchers report no relevant financial disclosures.