Role of surgical method in the treatment of type 2 diabetes mellitus associated with obesity

Abstract

Aim. To improve treatment of type 2 diabetes mellitus associated with obesity by analyzing the results of surgical treatment during a 24 months follow-up. Material and Methods. The study included 75 patients with type 2 diabetes and obesity. In the study, 32 patients of patients underwent biliopancreatic diversion with duodenal switch; sleeve gastrectomy was performed in 33 patients, and Roux-n-Y gastric bypass - in 10 patients. Mean age of the patients was 47.6±8.9 years - from 29 to 67 years (33 for men and 42 for women). Mean body weight before the procedure was 149.1±30.5 kg (from 87 to 236 kg), the average of excess body weight - 90,1±24,9 kg (51 to 147 kg). The average body mass index before intervention was 50.4±9.5 kg/m2 (from 30.1 to 75.4 kg/m2). The criteria of the American Diabetic Association (1998) were used to diagnose type 2 diabetes. The criteria recommended by Brethauer were used to evaluate the results of surgical treatment of type 2 diabetes mellitus and obesity. Results and Discussion. Combined oral hypoglycaemic therapy was given in 45 (60%) patients; insulin therapy in combination with oral hypoglycaemic drugs - in 11 (14.7%) patients. On admission, in 26 (34.7%) patients 2 type of diabetes mellitus was compensated; 9 (12%) patients had sub-compensation of diabetes; and 40 (53.3%) patients had decompensation. Biliopancreatic diversion with duodenal switch was performed in 32 patients - 18 women and 14 men. Mean body mass index was 53.6±8.3 kg/m2 (40.5 to 75.4 kg/m2). All patients were treated with open access. Sleeve gastrectomy was done in 33 patients - 19 women and 14 men. The average body mass index was 48.2±9.8 kg/m2 (from 30 to 73.9 kg/m2). All procedures were done laparoscopically. Roux-n-Y gastric bypass was performed in 10 patients - 5 women and 5 men. In 6 patients, laparoscopic access was used, and in 4 - open access was performed. In 2 years, 68 (90.7%) of the patients who remained in the study were asked for a follow-up visit. According to the laboratory tests, 22 (73,3%) patients after sleeve gastrectomy has complete stable remission. In the group of patients with biliopancreatic diversion, complete stable remission of type 2 diabetes was achieved in 27 (93.1%) patients, and in the gastric bypass group - in 7 (77,8%) patients. No clinically and laboratory significant hypoglycemia was diagnosed. The indicated results of surgical treatment were associated with a decrease in the level of insulin resistance markers (HOMA-IR, hyperinsulinemia) in all patient groups. Conclusions. Taking into account the results obtained, the high efficiency of metabolic surgical procedures in the treatment of type 2 diabetes associated with obesity has been established, with higher efficacy of combined surgical interventions over restrictive ones in comparison with sleeve gastrectomy. Further studies of the results of metabolic surgery are related to exploratiom of the antidiabetic effect stability regarding the safety profile of various techniques of surgical interventions in prolonged follow-up (the desired observation period of over 5 years).

Keywords

• type 2 diabetes mellitus, biliopancreatic diversion with duodenal switch, sleeve gastrectomy, roux-n-y gastric bypass