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

Frenken M, Cho EY, Karcz WK, Grueneberger J, Kuesters S - J Obes (2011)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, St. Josef Hospital Monheim, 40789 Monheim am Rhein, Germany.

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.

No MeSH data available.


Related in: MedlinePlus

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 <2.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3065014&req=5

fig3: 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 <2.

Mentions: Mean HOMA-IR index decreased from a preoperative value of 14.3 to 3.6, and 1.9 three and 7 days after surgery (Figure 3). There was no significant difference whether the patients were treated with oral antidiabetics or with insulin. Also, three patients who were discharged from hospital with small amounts of insulin (maximally 36 units per day) had a low postoperative HOMA-IR index of 1.3 to 2.6. No dependence of BMI on the postoperative course of insulin resistance could be detected.


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

Frenken M, Cho EY, Karcz WK, Grueneberger J, Kuesters S - J Obes (2011)

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 <2.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3065014&req=5

fig3: 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 <2.
Mentions: Mean HOMA-IR index decreased from a preoperative value of 14.3 to 3.6, and 1.9 three and 7 days after surgery (Figure 3). There was no significant difference whether the patients were treated with oral antidiabetics or with insulin. Also, three patients who were discharged from hospital with small amounts of insulin (maximally 36 units per day) had a low postoperative HOMA-IR index of 1.3 to 2.6. No dependence of BMI on the postoperative course of insulin resistance could be detected.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, St. Josef Hospital Monheim, 40789 Monheim am Rhein, Germany.

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.

No MeSH data available.


Related in: MedlinePlus