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01-10-2009 | Diabetes | Article

Ileal interposition surgery improves glucose tolerance for Type 2 diabetics

Abstract

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MedWire News: Two versions of laparascopic ileal interposition surgery and sleeve gastrectomy lead to significantly improved glucose tolerance in normal and overweight patients with Type 2 diabetes, show results presented at the European Association for the Study of Diabetes 45th Annual Meeting in Vienna, Austria.

“Bariatric surgery in morbidly obese diabetic patients induces a high percentage of diabetes resolution,” explained presenting author Sérgio Vencio (Hospital de especialidades, Goiania, Brazil).

As Type 2 diabetes is rarely resolved in patients who are normal or overweight (body mass index under 30 kg/m2), Vencio and colleagues carried out a study involving 94 Type 2 diabetic patients, aged 59 years on average, who underwent two versions of laparascopic ileal interposition surgery and sleeve gastrectomy.

Of these, one version involved the duodenum being kept in continuity with the stomach (II-SG; n=46) and the other involved a diversion of the second portion of the duodenum (II-DSG; n=48).

The average body mass index of the participants was 28.1 kg/m2 and mean glycated hemoglobin (HbA1c) was 8.63%.

The researchers performed a standard oral glucose tolerance test (75 g) both before and 8-15 months after surgery. Beta-cell function was estimated from C-peptide data and insulin sensitivity was measured using the oral glucose sensitivity index.

At their post surgery follow-up visit, 82% of the participants had achieved an optimum HbA1c of below 6.5% without the help of antidiabetic treatment, which was “independent of initial BMI or corresponding weight loss,” said Vencio. In addition, participants’ fasting plasma glucose levels were reduced by 38% and 2-hour fasting glucose by 51%.

Both beta cell function and insulin sensitivity were doubled following surgery and the total insulin output of the patients increased significantly, particularly in those with a lower baseline BMI.

Weight loss was significant and proportional to initial BMI as heavier patients lost more weight.

Of note, other baseline characteristics such as gender, age, duration of diabetes, HbA1c, and antidiabetic treatment did not predict resolution of diabetes or an HbA1c of below 6.5% at follow-up. Type of surgery also did not appear to significantly influence the results.

“These findings lend support to the concept that the terminal ileum releases neuroendocrine signals in response to feeding which favorably impact on glucose tolerance,” concludes the team.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Helen Albert