title: [Severe obesity and insulin resistance. Result obtained by the bilio-pancreatic diversion independentely for an associated gastroresection or gastropreservation].
abstract: BACKGROUND
  Type 2 diabetes is the paradigm of an obesity-related disease. In most cases it exists because of the obesity and will disappear with weight loss.
  
  
  OBJECTIVE
  To evaluate the glicemic control in obese patients after two malabsorbitive procedure, the bilio-pancreatic diversion with ad hoc stomach resection (BPD-AHS) and the bilio-pancreatic diversion with transitory gastric restriction (BPD-TGR).
  
  
  METHODS
  The effect of weight loss following malabsorbitive procedures was studied on 38 patients operated on between the May 1999 and July 2002. Ten patients were diabetes 2 type (group A, 4 patients with oral antidiabetic therapy and 6 with insulin therapy; mean BMI: 49.4 +/- 8.2 Kg/m2), 18 patients were glucose intolerance (group B; mean BMI: 48.2 +/- 6.4 Kg/m2) and 10 patients were in normal glicemic control (group C; mean BMI: 51.2 +/- 8.3 Kg/m2). Five patients in group A were operated on BPD-AHS and 5 patients on BPD-TGR. Ten patients in the group B were operated on BPD-AHS and 8 patients on BPD-TGR. After 3 months from the malabsorbitive procedure group A patients stopped antidiabetic (mean BMI was: 42.3) and group B patients had normal values of glucose and insuline (mean BMI: 41.8). No significant statistically differences were observed in terms of glicemic control, BMI and Excess Weight Loss (EWL%), comparing the two malabsorbitive procedure.
  
  
  RESULTS
  Weight loss after both BPD-AHS and BPD-TGR had a beneficial and durable effect on the fasting plasma glucose and serum insuline levels in diabetic and non-diabetic obese patients. The gastric procedure did not change the glicemic control.
authors.affiliation: Cattedra di Chirurgia Generale, Università degli Studi di Brescia, 10 Divisione di Chirurgia Generale, Spedali Civili di Brescia.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Betta
authors.forename: Francesco
authors.initials: F
authors.lastname: Mittempergher
authors.forename: Carmen
authors.initials: C
authors.lastname: Terraroli
authors.forename: Eleonora
authors.initials: E
authors.lastname: Valloncini
authors.forename: Bruno
authors.initials: B
authors.lastname: Salerni
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013270:Stomach / Q000601:surgery