Improvement of type 2 diabetes mellitus in obese and non-obese patients after the duodenal switch operation

Abstract

Introduction. Type 2 diabetes mellitus (T2DM) is one of the most important obesity-related comorbidities. This study was undertaken to characterise the effect of the biliopancreatic diversion with duodenal switch (BPD-DS) in morbidly obese and nonmorbidly obese diabetic patients. Methods. Outcome of 74 obese diabetic patients after BPD-DS and 16 non-obese diabetic patients after BPD or gastric bypass surgery was evaluated. Insulin usage, HbA(1c)-levels, and index of HOMA-IR (homeostasis model assessment of insulin resistence) were measured. Results. A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA(1c)-levels). Conclusion. BPD-DS leads to an improvement of T2DM in obese and non-obese patients. Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients.

Figures

Figure 1

Reduction of insulin usage prior to BPD-DS, at discharge and one year after the operation. Blue dots indicate the number of patients in need of insulin (right scale). Red bars indicate the mean amount of insulin used per day (left scale, whiskers indicate standard deviation).

Figure 2

HbA1c levels prior to BPD-DS and 3, 6, and 12 months after the operation. Red bars indicate the mean levels of HbA1c, whiskers indicate standard deviation.

Figure 3

HOMA index at the day of surgery and 3, 7, 14, and 21 days after BPD-DS (27 patients). Green bars indicate mean HOMA index (whiskers indicate minimum and maximum values). Seven days after the operation, the mean HOMA index reaches a normal value

Figure 4

Reduction of insulin usage after BPD-DS dependent on preoperative duration of insulin usage. Group I “OAD” was treated by oral antidiabetic drugs only and used no insulin postoperatively. Group II used insulin for less than 5 years preoperatively and needed no insulin at discharge and after. Group III used insulin for 5 to 10 years. Thirty-seven percent of patients in this group needed insulin at discharge (light brown bar), but all patients in this group were free of insulin 1 year after the operation. Group IV used insulin for more than 10 years. Seventy-three percent of patients in this group needed insuline at discharge (light brown bar), 23% of patients in this group still needed insuline 1 year after the operation (white bar).

Figure 5

HbA1c levels after BPD-DS dependent on preoperative duration of insuline usage. Group I “OAD” was treated by oral antidiabetic drugs only. HbA1c levels were below 6% as early as 3 months after the operation. Group II used insulin for less than 5 years preoperatively and also showed normal levels of HbA1c from 3 months after the operation on. Group III used insulin for 5 to 10 years. Mean HbA1c normalized 6 months after the operation. Group IV used insulin for more than 10 years. Mean HbA1c in this group normalized not until 2 years after the operation. Shown are mean values and additionally minimum/maximum values for preoperative and 2 years data.