Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch.

Abstract

BACKGROUND:

Biliopancreatic diversion with duodenal switch (BPD-DS) confers the highest rate of type 2 diabetes (T2D) remission compared with other bariatric procedures. Previous studies suggest that type of antidiabetic therapy used before surgery and duration of disease influence postsurgical glycemic outcomes. Short-term, progressive improvement in insulin sensitivity and beta-cell function after metabolic surgery in patients with noninsulin-treated T2D has been demonstrated. Whether patients with more advanced disease can achieve sustained remission remains unclear.

OBJECTIVE:

The aim of this study was to assess long-term glycemic outcomes in insulin-treated patients with T2D after BPD-DS and identify predictors of sustained diabetes remission or relapse.

SETTING:

University-affiliated tertiary care center.

METHODS:

Data from 141 patients with insulin-treated T2D who underwent BPD-DS between 1994 and 2006 with 10 years of follow-up data were collected from a prospective electronic database.

RESULTS:

Follow-up was available in 132 patients (91%). At 10 years after metabolic surgery, 90 patients (68.1%) had a complete remission of diabetes, 3 (2.3%) had a partial remission, 21 (15.9%) had an improvement, and 3 (2.3%) were unchanged in their diabetes status. Fourteen patients died during the 10-year follow-up period. Relapse after an initial period of remission occurred in 15 (11.4%) patients. Insulin discontinuation was achieved in 97%. Duration of diabetes was an independent predictor of nonremission at 10 years.

CONCLUSIONS:

The BPD-DS maintains remission at 10 years postoperatively in patients with more advanced diabetes. Long-term benefits of the BPD-DS on weight loss and glycemic control should be considered when offering metabolic surgery to patients with insulin-treated T2D.

• Authors: Jordanna E Kapeluto, André Tchernof, Daiana Masckauchan, Simon Biron, Simon Marceau, Frédéric-Simon Hould, Stéfane Lebel, Odette Lescelleur, François Julien, Laurent Biertho
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) Vol. 16 Issue 11 Pg. 1701-1712 (Nov 2020) ISSN: 1878-7533 [Electronic] United States
• PMID: 32800734 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Chemical References

• Insulin

Topics

• Biliopancreatic Diversion
• Diabetes Mellitus, Type 2 (drug therapy, surgery)
• Humans
• Insulin (therapeutic use)
• Obesity, Morbid (surgery)
• Prospective Studies
• Weight Loss