Laparoscopic sleeve gastrectomy
with ileal interposition sent diabetes into remission in 20 of 43 adults
and reduced the need for diabetes medications in the other 23 patients
during an average of 20 months of follow-up.
Among
the 30 obese (defined as having a body mass index greater than 27
kg/m2) patients in the study, 26 showed remission of diabetes – an 86%
success rate that’s similar to results reported for gastric bypass
surgery, Dr. Kirtikumar D. Modi said in a press briefing at the annual
meeting of the Endocrine Society.
Laparoscopic
diverted sleeve gastrectomy diverts food away from parts of the small
intestine, including the duodenum, where the absorption of nutrients
begins, and the ileal segment is shifted more proximally. Patients who
underwent this procedure had had diabetes for 15 years on average, and
they had an average BMI of 29 as well as stimulated C-peptide levels
greater than 4 ng/mL.
At 9
months after surgery, diabetes was in remission in 12 (70%) of the 17
patients, and the other 5 patients needed fewer oral hyperglycemic
medications than did those in the first series.
All
patients in both studies had poorly controlled diabetes. The
investigators defined diabetes remission as a hemoglobin A1c level less
than 6.5% and no further need for insulin or oral hypoglycemic agents.
The
reduction in hemoglobin A1c was disproportionately greater than the
decline in BMI, suggesting benefits that are "much more than the weight
improvement," he said.
More
complications were seen in the second series, including three patients
with minor intraoperative complications. Another patient developed ileus
with ileal perforation 2 weeks after surgery and underwent laparotomy
for repair. Three patients experienced nausea and anorexia for 2 weeks.
Two patients developed vitamin B12 deficiency at 12 months.
source:http://www.internalmedicinenews.com/news/diabetes-endocrinology-metabolism/single-article/modified-bariatric-surgery-tames-diabetes-in-small-series/793ee9bd8fa374d3737a787d0156a961.html
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