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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

HbA1c levels after BPD-DS dependent on preoperative duration of insuline usage. Group I “OAD” was treated by oral antidiabetic drugs only. HbA1c levels were below 6% as early as 3 months after the operation. Group II used insulin for less than 5 years preoperatively and also showed normal levels of HbA1c from 3 months after the operation on. Group III used insulin for 5 to 10 years. Mean HbA1c normalized 6 months after the operation. Group IV used insulin for more than 10 years. Mean HbA1c in this group normalized not until 2 years after the operation. Shown are mean values and additionally minimum/maximum values for preoperative and 2 years data.
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fig5: HbA1c levels after BPD-DS dependent on preoperative duration of insuline usage. Group I “OAD” was treated by oral antidiabetic drugs only. HbA1c levels were below 6% as early as 3 months after the operation. Group II used insulin for less than 5 years preoperatively and also showed normal levels of HbA1c from 3 months after the operation on. Group III used insulin for 5 to 10 years. Mean HbA1c normalized 6 months after the operation. Group IV used insulin for more than 10 years. Mean HbA1c in this group normalized not until 2 years after the operation. Shown are mean values and additionally minimum/maximum values for preoperative and 2 years data.

Mentions: According to their need for insulin, patients in group 3 were divided into 4 groups: 15 patients were treated with oral antidiabetic medication, 25 used insulin for less than 5 years, 23 used insulin for 5–10 years, and 11 used insulin for more than 10 years. At discharge from hospital, all patients in groups I and II were free of insulin. Thirty-three percent of patients in group III, still needed insulin at the time of discharge, but all of them were free of insulin 12 months after the operation. In group IV, 73% needed insulin at the time of discharge, 23% still needed small amounts of insulin 12 months after the operation (Figure 4). HbA1c levels also decreased continuously in all groups. Mean levels below 6% were reached 3 month after surgery in groups I and II, 6 month after surgery in group III and 2 years after surgery in group IV (Figure 5).


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)

HbA1c levels after BPD-DS dependent on preoperative duration of insuline usage. Group I “OAD” was treated by oral antidiabetic drugs only. HbA1c levels were below 6% as early as 3 months after the operation. Group II used insulin for less than 5 years preoperatively and also showed normal levels of HbA1c from 3 months after the operation on. Group III used insulin for 5 to 10 years. Mean HbA1c normalized 6 months after the operation. Group IV used insulin for more than 10 years. Mean HbA1c in this group normalized not until 2 years after the operation. Shown are mean values and additionally minimum/maximum values for preoperative and 2 years data.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: HbA1c levels after BPD-DS dependent on preoperative duration of insuline usage. Group I “OAD” was treated by oral antidiabetic drugs only. HbA1c levels were below 6% as early as 3 months after the operation. Group II used insulin for less than 5 years preoperatively and also showed normal levels of HbA1c from 3 months after the operation on. Group III used insulin for 5 to 10 years. Mean HbA1c normalized 6 months after the operation. Group IV used insulin for more than 10 years. Mean HbA1c in this group normalized not until 2 years after the operation. Shown are mean values and additionally minimum/maximum values for preoperative and 2 years data.
Mentions: According to their need for insulin, patients in group 3 were divided into 4 groups: 15 patients were treated with oral antidiabetic medication, 25 used insulin for less than 5 years, 23 used insulin for 5–10 years, and 11 used insulin for more than 10 years. At discharge from hospital, all patients in groups I and II were free of insulin. Thirty-three percent of patients in group III, still needed insulin at the time of discharge, but all of them were free of insulin 12 months after the operation. In group IV, 73% needed insulin at the time of discharge, 23% still needed small amounts of insulin 12 months after the operation (Figure 4). HbA1c levels also decreased continuously in all groups. Mean levels below 6% were reached 3 month after surgery in groups I and II, 6 month after surgery in group III and 2 years after surgery in group IV (Figure 5).

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