Endocrine Abstracts

Objective: To prospectively evaluate the results of laparoscopic ileal interposition (II) with diverted sleeve gastrectomy (DSG) for control of type 2 diabetes mellitus (T2DM) and related metabolic abnormalities.

Methods: All patients underwent II +DSG. They had T2DM ≥5 years with poor glycemic control despite adequate dosage of oral hypoglycemic agents (OHAs) and/ or insulin. The primary outcome was remission of diabetes (HbA1c <6.5% without OHAs/insulin). Secondary outcomes were reduction in antidiabetic agent requirement and components of metabolic syndrome.

Results: We report the postoperative follow-up data of 13.1±5.3 months (range: 3–26 months). There were 32 patients (male: female=21:11) with mean age of 48.7±7.8 (range, 34–66 years), duration of diabetes of 13.1±5.8 years (range, 5–30 years), and preoperative body mass index of 29.1±6.9 kg/m² (range: 22.4–39.5 kg/m²). They had poorly controlled diabetes with mean FBS: 236.52±88.4 mg/dl, PLBS: 305. 1±124.3 mg/dl and HbA1c: 9.8±1.8%. Sixteen patients (50%) had hypertension, while dyslipidemia and microalbuminuria was present in 12 patients (39%) each.

The mean operative time was 387.7±84.3 minutes and the mean postoperative hospital stay was 8.8±5.4 days. Intraoperative complications were noted in 4 patients (12.5%). Nausea and loss of appetite was observed in 3 patients (10%), which improved over a period of 2 weeks. At 3 months postoperative follow up, none of these patients had any complications with regards to the intraoperative and immediate postoperative events.

Twenty two patients (70.5%) had diabetes remission. Fifteen/sixteen (93%) patients had remission in hypertension. All participants had weight loss ranging between 15 and 25%. Postoperatively statistically significant decline was observed in the glycemic and lipid parameters, microalbuminuria at all intervals (P<0.05). Patients with duration of follow up more than 6 months demonstrated to have better improvement in terms of reduction in glycemic, lipid parameters and microalbuminuria. Three patients had vitamin B12 deficiency 1 year after surgery.

Discussion: The surgery addresses the foregut and hindgut mechanisms for DM control. The DSG component restricts calorie intake and induces ghrelin (orexin) loss. It also excludes the duodenal loop, thereby negating the effect of insulin resistance promoting Rubino’s factor. II leads to earlier and rapid stimulation of interposed ileal segment by ingested food resulting in augmented GLP-1 secretion.

Conclusion: II+DSG seem to be promising procedures for control of type 2 DM and associated metabolic abnormalities.