Gastrectomy with ileal transposition promising for mildly obese diabetics

Last Updated: 2016-04-22

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Mildly obese patients with uncontrolled type 2 diabetes may achieve better glycemic control after undergoing sleeve gastrectomy with ileal transposition (sleeve-IT) than after gastric bypass or clinical treatment, new research from Brazil suggests.

"Our study shows that the new technique of combining sleeve gastrectomy with ileal transposition in patients with mild obesity was effective and safe," said Dr. Ana Priscila Soggia of the Hospital Sirio-Libanes in Sao Paulo. "The patients receiving sleeve-IT surgery attained excellent glycemic control after one year with no increase in adverse events, compared with the patients undergoing conventional surgical technique."

"Bariatric surgery is known to lead to weight loss and diabetes remission in more severely obese groups, but not much is known about the impact of surgery on mildly obese diabetic patients, those with body mass index 30 to 35," she told Reuters Health by email.

"Although we expected a difference between the surgical and medical treatments the difference between the two types of surgery after one year of treatment was beyond our expectations," she said.

Dr. Soggia and her colleagues presented their findings on April 1 at the annual meeting of the Endocrine Society in Boston.

The researchers enrolled 42 mildly obese participants with uncontrolled type 2 diabetes (mean age, 51) and randomly assigned them to receive one of three treatments: clinical diabetes treatment, gastric bypass surgery or sleeve-IT surgery.

The average baseline glycated hemoglobin was 9.3%. After one year, glycated hemoglobin of 6.5% or less was achieved in 8% (one of 12 patients) in the clinical group vs 46% (6 of 13 patients) in the bypass group and 100% (12 of 12 patients) in the sleeve-IT group (p=0.002, bypass vs. sleeve).

Diabetes remission - glycemic control without medication - was reached in 30% (four of 13 patients) in the bypass group vs. 75% (nine of 12 patients) in the sleeve-IT group (p=0.02).

Glycemic control improved in all groups. The mean glycated hemoglobin level was 8% in the clinical group, 6.9% in the bypass group and 5.6% in the sleeve-IT group (p=0.01, bypass vs. sleeve).

Weight loss was greater after bypass (22.5 kg, p=0.003) and sleeve-IT surgery (18 kg, p=0.017) than in the clinical group (4.7 kg). After surgery in both groups, use of drugs to lower glucose, lipid, and blood pressure decreased.

Four serious adverse events, but no deaths or life-threatening complications, were reported.

The research team plans to continue to assess how well these results are maintained over 24 to 36 months of follow-up. "We also need to evaluate the long-term nutritional and intestinal adverse events," Dr. Soggia said.

The Hospital Sirio-Libanes sponsored the study. The authors had no disclosures.

SOURCE: http://bit.ly/1VpwQZy

ENDO 2016.