Gianmattia Del Genio1, Michel Gagner2, Paolo Limongelli3, Salvatore Tolone3, Dimitri Pournaras4, Carel W le Roux5, Luigi Brusciano3, Anna Licia Mozzillo3, Federica Del Genio6, Ludovico Docimo3. 1. Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy. Electronic address: gianmattia.delgenio@unina2.it. 2. Department of Surgery, Hopital Du Sacre Coeur, Montreal, QC, Canada. 3. Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy. 4. Investigative Science, Imperial College London, London, UK. 5. Investigative Science, Imperial College London, London, UK; Diabetes Complications Research Centre, UCD Conway Institute, University College Dublin, Dublin, Ireland. 6. Center of Esophago-gastric and Bariatric Surgery (E.G.O.), Clinica C.G. Ruesch(,) Naples, Italy.
Abstract
BACKGROUND: Nutrient interaction with the mid-gut may play a role in improving type 2 diabetes mellitus (T2D) after bariatric surgery. However, Roux-en-Y gastric bypass, biliopancreatic diversion, and sleeve gastrectomy include diversion of food from the duodenum and/or partial gastrectomy. Biliointestinal bypass (BIBP) was introduced to eliminate the major side effects of jejunoileal bypass. It does not involve any change to the anatomy of the stomach or the duodenum. A prospective evaluation of the role of BIBP in glycemic control has not been reported. OBJECTIVES: Longitudinal evaluation of T2D after BIBP. SETTING: University hospitals in Europe and Canada. METHOD: The effects of BIBP on metabolism and glycemia in 28 consecutive patients with T2D were evaluated over 2 years. RESULTS: Decreases (P<.001) in fasting glycemia, insulinemia, and homeostasis model assessment were observed 3 months after surgery, were improved after 1 year, and remained stable after 2 years. Glycosylated hemoglobin levels decreased at 3, 12, and 24 months after surgery (from 9.2±2.1 to 6.3±1.1 (P<.0001), 4.9±1.7 (P<.0001), and 4.8±1.1 (P<.0001), after 3, 12, and 24 months, respectively). Medical therapy was discontinued in 83% (20 of 24) of the patients; for the remaining 17% (4 of 24), therapy was reduced to oral hypoglycemic agents. CONCLUSION: BIBP had a favorable risk-benefit relationship and positive metabolic effects in the short term. How BIBP achieves optimal glycemic control and whether it improves β-cell function and/or insulin sensitivity require further study.
BACKGROUND: Nutrient interaction with the mid-gut may play a role in improving type 2 diabetes mellitus (T2D) after bariatric surgery. However, Roux-en-Y gastric bypass, biliopancreatic diversion, and sleeve gastrectomy include diversion of food from the duodenum and/or partial gastrectomy. Biliointestinal bypass (BIBP) was introduced to eliminate the major side effects of jejunoileal bypass. It does not involve any change to the anatomy of the stomach or the duodenum. A prospective evaluation of the role of BIBP in glycemic control has not been reported. OBJECTIVES: Longitudinal evaluation of T2D after BIBP. SETTING: University hospitals in Europe and Canada. METHOD: The effects of BIBP on metabolism and glycemia in 28 consecutive patients with T2D were evaluated over 2 years. RESULTS: Decreases (P<.001) in fasting glycemia, insulinemia, and homeostasis model assessment were observed 3 months after surgery, were improved after 1 year, and remained stable after 2 years. Glycosylated hemoglobin levels decreased at 3, 12, and 24 months after surgery (from 9.2±2.1 to 6.3±1.1 (P<.0001), 4.9±1.7 (P<.0001), and 4.8±1.1 (P<.0001), after 3, 12, and 24 months, respectively). Medical therapy was discontinued in 83% (20 of 24) of the patients; for the remaining 17% (4 of 24), therapy was reduced to oral hypoglycemic agents. CONCLUSION:BIBP had a favorable risk-benefit relationship and positive metabolic effects in the short term. How BIBP achieves optimal glycemic control and whether it improves β-cell function and/or insulin sensitivity require further study.
Authors: Valerio Ceriani; Giuliano Sarro; Giancarlo Micheletto; Alessandro Giovanelli; Ahmed S Zakaria; Marco Fanchini; Chiara Osio; Italo Nosari; Alberto Morabito; Antonio E Pontiroli Journal: Int J Obes (Lond) Date: 2018-11-23 Impact factor: 5.095