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Ileal interposition coupled with duodenal diverted sleeve gastrectomy versus standard medical treatment in type 2 diabetes mellitus obese patients: long-term results of a case–control study

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Abstract

Background

Randomized controlled trials have demonstrated that bariatric surgery is effective in obtaining remission of type 2 diabetes mellitus (T2DM) in obese patients, yet no data exist in the literature from prospective studies with ileal interposition with duodenal diversion sleeve gastrectomy (II-DD-SG). The aim of this case–control study is to investigate if II-DD-SG is superior to medical treatment in T2DM obese patients.

Methods

Thirty obese patients (BMI > 30) affected by T2DM were recruited for surgery (II-DD-SG) between 2008 and 2011 and were matched with an equal control group which received standard medical treatment. Anthropometric measures, glucose metabolism, cardiovascular risk factors were determined baseline and during follow-up. The primary end point was T2DM remission; reduction of body weight, BMI, and cardiovascular risk factors were secondary end-points.

Results

Shortly after II-DD-SG, normalization of glucose plasma levels and glycated hemoglobin was observed followed by a significant decrease in body weight and BMI. At one-year follow-up, insulin resistance strongly declined as did insulin plasma levels. Complete remission was observed in 26 patients (86%); 2 (6.6%) had partial remission, and two (6.6%) were still diabetic. After 5 years, 17 of 25 patients on follow-up (68%) showed complete remission of T2DM and 56% had remission of cardiovascular risk factors. Only two patients receiving medical treatment showed complete remission of T2DM (p < 0.0001 versus II-DD-SG). No significant changes of anthropometric parameters and lipid metabolism were recorded.

Conclusions

II-DD-SG is an effective surgical procedure, able to induce complete and prolonged remission of T2DM in obese patients as opposed to medical treatment.

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References

  1. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, de Ramon RA, Israel G, Dolezal JM (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222:339–350

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  CAS  PubMed  Google Scholar 

  3. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256

    Article  PubMed  Google Scholar 

  4. Abbatini F, Rizzello M, Casella G, Alessandri G, Capoccia D, Leonetti F, Basso N (2010) Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass and adjustable gastric banding on type 2 diabetes. Surg Endosc 24:1005–1010

    Article  CAS  PubMed  Google Scholar 

  5. Aminian A, Brethauer SA, Andalib A, Punchai S, Mackey J, Rodriguez J, Rogula T, Kroh M, Schauer PR (2016) Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes. Ann Surg 264:674–681

    Article  PubMed  Google Scholar 

  6. Lee WJ, Chong K, Lin YH, Wei JH, Chen SC (2014) Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5 year results of a randomized trial and study of incretin effect. Obes Surg 24:1552–1562

    Article  PubMed  Google Scholar 

  7. Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC (2008) Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus. Comparison of BMI> 35 and < 35 Kg/m2. J Gastrointest Surg 12:945–952.

    Article  PubMed  Google Scholar 

  8. Huang CK, Tai CM, Chang PC, Malapan K, Tsai CC, Yolsuriyanwong K (2016) Loop duodenojejunal bypass with sleeve gastrectomy: comparative study with Roux-en-Y gastric bypass in type 2 diabetic patients with BMI < 35 Kg/m2, first year results. Obes Surg 26:2291–2301.

    Article  PubMed  Google Scholar 

  9. Sánchez-Pernaute A, Rubio M, Cabrerizo L, Ramos-Levi A, Pérez-Aguirre E, Torres A (2015) Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients. Surg Obes Relat Dis 11:1092–1098

    Article  PubMed  Google Scholar 

  10. DePaula AL, Stival AR, DePaula CC, Halpern A, Vêncio S (2010) Impact on the dyslipidemia of the laparoscopic ileal interposition associated to sleeve gastrectomy in type 2 diabetic patients. J Gastrointest Surg 14:1319–1325

    Article  PubMed  Google Scholar 

  11. DePaula AL, Macedo AL, Mota BR, Schraibman V (2009) Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc 23:1313–1320

    Article  CAS  PubMed  Google Scholar 

  12. Santoro S, Castro LC, Velhote MC, Malzoni CE, Klajner S, Castro LP, Lacombe A, Santo MA (2012) Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg 256:104–110

    Article  PubMed  Google Scholar 

  13. Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D (2017) Non-communicable disease syndemics: poverty, depression and diabetes among low-income populations. Lancet 389:951–963

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dixon JB, O’Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, Proietto J, Bailey M, Anderson M (2008) Adjustable gastric banding and conventional therapy for type 2 diabetes. JAMA 299:316–323

    CAS  PubMed  Google Scholar 

  15. Ding SA, Simonson DC, Wewalka M, Halperin F, Foster K, Goebel-Fabbri A, Hamdy O, Clancy K, Lautz D, Vernon A, Goldfine AB (2015) Adjustable gastric band surgery or medical management in patients with type 2 diabetes: a randomized clinical trial. J Clin Endocrinol Metab 100:2546–2556

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366:1567–1576

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Kashyap SR, STAMPEDE Investigators (2017) Bariatric surgery versus intensive medical therapy for diabetes- 5-year outcomes. N Engl J Med 376:641–651

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kashyap SR, Bhatt DL, Wolski K, Watanabe RM, Abdul-Ghani M, Abood B, Pothier CE, Brethauer S, Nissen S, Gupta M, Kirwan JP, Schauer PR (2013) Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes. Diabetes Care 36:2175–2182

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, Thomas AJ, Leslie DB, Chong K, Jeffery RW, Ahmed L, Vella A, Chuang LM, Bessler M, Sarr MG, Swain JM, Laqua P, Jensen MD, Bantle JP (2013) Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia. JAMA 309:2240–2249

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Halperin F, Ding SA, Simonson DC, Panosian J, Goebel-Fabbri A, Wewalka M, Hamdy O, Abrahamson M, Clancy K, Foster K, Lautz D, Vernon A, Goldfine AB (2014) Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes. Feasibility and 1-year results of a randomized clinical trial. JAMA Surg 149:716–726

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cummings DE, Arterburn DE, Westbrook EO, Kuzma JN, Stewart SD, Chan CP, Bock SN, Landers JT, Kratz M, Foster-Schubert KE, Flum DR (2016) Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia 59:945–953

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F (2012) Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366:1577–1585

    Article  CAS  PubMed  Google Scholar 

  23. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, Castagneto M, Bornstein S, Rubino F (2015) Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomized controlled trial. Lancet 386:964–973

    Article  PubMed  Google Scholar 

  24. Ballesteros-Pomar MD, González de Francisco T, Urioste-Fondo A, González-Herraez L, Calleja-Fernández A, Vidal-Casariego A, Simó-Fernández V, Cano-Rodríguez I (2016) Biliopancreatic diversion for severe obesity: long-term effectiveness and nutritional complications. Obes Surg 26:38–44

    Article  PubMed  Google Scholar 

  25. Strader A, Vahl TP, Jandacek RJ, Woods SC, D’Alessio DA, Seeley RJ (2005) Weight loss through ileal transposition is accompained by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab 288:E 447–453

    Article  CAS  Google Scholar 

  26. Cummings BP, Strader AD, Stanhope KL, Graham JL, Lee J, Raybould HE, Baskin DG, Havel PJ (2010) Ileal interposition surgery improves glucose and lipid metabolism and delays diabetes onset in the UCD-T2DM rats. Gastroenterology 138:2437–2446

    Article  CAS  PubMed  Google Scholar 

  27. Foschi DA, Rizzi A, Tubazio I, Conti L, Vago T, Bevilacqua M, Magni A, Del Puppo M (2015) Duodenal diverted sleeve gastrectomy with ileal interposition does not cause biliary salt malabsorption. Surg Obes Relat Dis 11:372–376

    Article  PubMed  Google Scholar 

  28. American Diabetes Association (2003) Management of dyslipidemia in adults with diabetes. Diabetes Care 26(S1):S83–S86

    Google Scholar 

  29. Foschi D, Rizzi A, Tubazio I (2017) Ileal interposition. In: Angrisani L (ed) Bariatric and metabolic surgery. Elsevier Italia, Milan

    Google Scholar 

  30. DePaula AL, Macedo AL, Prudente AS, Queiroz L, Schraibman V, Pinus J (2006) Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”)—pilot study of a new operation. Surg Obes Relat Dis 2:464–467

    Article  Google Scholar 

  31. Friedewald WT, Levy RI, Fredricson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of preparative ultracentrifuge. Clin Chem 18:499–502

    CAS  PubMed  Google Scholar 

  32. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419

    Article  CAS  PubMed  Google Scholar 

  33. Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, McLaughlin S, Phillips GL 2nd, Robertson RP, Rubino F, Kahn R, Kirkman MS (2009) How do we define cure of diabetes? Diabetes Care 32:2133–2135

    Article  PubMed  PubMed Central  Google Scholar 

  34. Dixon JB, Zimmet P, Alberti KG, Rubino F, International Diabetes Federation Taskforce on Epidemiology and Prevention (2011) Bariatric surgery an IDF statement for obese type 2 diabetes. Diabet Med 28:628–642

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 ptients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE, Delegates of the 2nd Diabetes Surgery Summit (2017) Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Obes Surg 27:2–21

    Article  PubMed  Google Scholar 

  37. Ashrafian H, Le Roux CW (2009) Metabolic surgery and gut hormones—a review of bariatric entero-humoral modulation. Physiol Behav 97:620–631

    Article  CAS  PubMed  Google Scholar 

  38. Carlsson LM, Peltonen M, Ahlin S, Anveden Å, Bouchard C, Carlsson B, Jacobson P, Lönroth H, Maglio C, Näslund I, Pirazzi C, Romeo S, Sjöholm K, Sjöström E, Wedel H, Svensson PA, Sjöström L (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 367:695–704

    Article  CAS  PubMed  Google Scholar 

  39. Sjöström L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden Å, Bouchard C, Carlsson B, Karason K, Lönroth H, Näslund I, Sjöström E, Taube M, Wedel H, Svensson PA, Sjöholm K, Carlsson LM (2014) Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 311:2297–2304

    Article  CAS  PubMed  Google Scholar 

  40. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761

    Article  CAS  PubMed  Google Scholar 

  41. Haluzíková D, Lacinová Z, Kaválková P, Drápalová J, Křížová J, Bártlová M, Mráz M, Petr T, Vítek L, Kasalický M, Haluzík M (2013) Laparoscopic sleeve gastrectomy differentially affects serum concentrations of FGF-19 and FGF-21 in morbidly obese subjects. Obesity 21:1335–1342

    Article  CAS  PubMed  Google Scholar 

  42. Koopmans HS, Sclafani A, Fichtner C, Aravich PF (1982) The effects of ileal transposition on food intake and body weight loss in VMH-obese rats. Am J Clin Nutr 35:284–293

    Article  CAS  PubMed  Google Scholar 

  43. Laessle C, Nenova G, Marjanovic G, Seifert G, Kousoulas L, Jaernigen B, Fichtner-Feigel S, Fink JM (2018) Duodenal exclusion but not sleeve gastrectomy preserves insulin secretion, making it the more effective metabolic procedure. Obes Surg 28:1406–1416

    Article  Google Scholar 

  44. Celik A, Ugale S, Ofluoglu H, Asci M, Celik BO, Vural E, Aydin M (2015) Technical feasibility and safety profile of laparoscopic diverted sleeve gastrectomy with ileal interposition (DSIT). Obes Surg 25:1184–1190

    Article  PubMed  Google Scholar 

  45. DePaula AL, Macedo AL, Schraibman V, Mota BR, Vencio S (2009) Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus with BMI 20–34. Surg Endosc 23:1724–1732

    Article  PubMed  Google Scholar 

  46. Morton JM, Carg T, Nguyen N (2014) Does hospital accreditation impact bariatric surgery safety? Ann Surg 260:504–508

    Article  PubMed  Google Scholar 

  47. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, Bertran E, Jaber L (2016) Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 37:88–99

    Article  PubMed  Google Scholar 

  48. Noordzij PG, Boersma E, Schreiner F, Kertai MD, Feringa HH, Dunkelgrun M, Bax JJ, Klein J, Poldermans D (2007) Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing non cardiac, non vascular surgery. Eur J Endocrinol 156:137–142

    Article  CAS  PubMed  Google Scholar 

  49. DePaula AL, Stival A, Halpern A, Vencio S (2011) Thirty-day morbidity and mortality of the laparoscopic ileal interposition associated to sleeve gastrectomy for the treatment of type 2 diabetic patients with BMI < 35: an analysis of 454 consecutive patients. World J Surg 35:102–108

    Article  PubMed  Google Scholar 

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Funding

None declared.

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Authors and Affiliations

  1. Chair of General Surgery, Department of Biomedical and Clinical Sciences “Luigi Sacco”, L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy

    Diego Foschi, Luca Sorrentino, Igor Tubazio, Andrea Rizzi & Fabio Corsi

  2. Unit of Dietetics, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy

    Consuelo Vecchio

  3. Endocrine Laboratory Unit, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy

    Tarcisio Vago

  4. Unit of Endocrinology, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy

    Maurizio Bevilacqua

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  1. Diego Foschi
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  2. Luca Sorrentino
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  3. Igor Tubazio
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  4. Consuelo Vecchio
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  5. Tarcisio Vago
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  6. Maurizio Bevilacqua
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  7. Andrea Rizzi
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Correspondence to Diego Foschi.

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Disclosures

Prof. Diego Foschi, Dr. Luca Sorrentino, Dr. Igor Tubazio, Dr. Consuelo Vecchio, Dr. Tarcisio Vago, Dr. Maurizio Bevilacqua, Dr. Andrea Rizzi, Prof. Fabio Corsi have no conflicts of interest or financial ties to disclose.

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Foschi, D., Sorrentino, L., Tubazio, I. et al. Ileal interposition coupled with duodenal diverted sleeve gastrectomy versus standard medical treatment in type 2 diabetes mellitus obese patients: long-term results of a case–control study. Surg Endosc 33, 1553–1563 (2019). https://doi.org/10.1007/s00464-018-6443-2

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