title: Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20-34.
abstract: BACKGROUND
  A group of patients with type 2 diabetes mellitus (T2DM) and body mass index (BMI) 20-34 kg/m(2) were submitted to laparoscopic interposition of a segment of ileum into the proximal jejunum or into the proximal duodenum associated to a sleeve gastrectomy. The objective of this study is to evaluate the hormonal changes in the pre- and postoperative period.
  
  
  METHODS
  Hormonal evaluation was done in 58 patients operated between April 2005 and July 2006. Mean age was 51.4 years (40-66 years). Mean BMI was 28.2 (20-34.8) kg/m(2). All patients had had the diagnosis of T2DM for at least 3 years. Mean duration of T2DM was 9.6 years (3-22 years). Two techniques were performed, consisting of different combinations of ileal interposition (II) associated to a sleeve gastrectomy (SG). The following hormones were assayed in the pre- and postoperative period (mean 16 months) at the baseline and following specific food stimulation (30, 60, 120 min): glucogen-like protein 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), insulin, glucagon, C-peptide, amylin, cholecystokinin (CCK), pancreatic polypeptide (PPP), somatostatin, peptide YY (PYY), ghrelin, adiponectin, resistin, leptin, and interleukin-6 (IL-6).
  
  
  RESULTS
  Thirty patients had II associated to sleeve gastrectomy (II-SG) and 28 had II with diverted sleeve gastrectomy (II-DSG). GLP1 exhibited an important rise following the two operations, especially after II-DSG (p < 0.001). GIP also exhibited an important rise, with both II-SG and II-DSG being equally effective (p < 0.001). Insulin and amylin showed a significant rise at 30 min. Glucagon decreased slightly. CCK measurements were very low after II-DSG. PPP was also slightly altered by the II-DSG. PYY showed an important increase with both operations (p < 0.001). Ghrelin showed a significant decrease following the two operations (p < 0.001). Somatostatin and IL-6 were not affected (p = 0.632). Both leptin and resistin blood levels decreased. Adiponectin showed a slight increase. Mean postoperative follow-up was 19.2 months. Both II-SG and II-DSG were effective in achieving adequate glycemic control (91.2%).
  
  
  CONCLUSIONS
  There was a significant hormonal change following laparoscopic ileal interposition. These alterations may explain the promising good results associated to these operations for the treatment of T2DM in the nonmorbidly obese population.
authors.affiliation: Gastrointestinal Surgery, Hospital de Especialidades, Goiania, Brazil. adepaula@uol.com.br
authors.forename: Aureo Ludovico
authors.initials: AL
authors.lastname: DePaula
authors.forename: A L V
authors.initials: AL
authors.lastname: Macedo
authors.forename: V
authors.initials: V
authors.lastname: Schraibman
authors.forename: B R
authors.initials: BR
authors.lastname: Mota
authors.forename: S
authors.initials: S
authors.lastname: Vencio
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005768:Gastrointestinal Hormones / Q000097:blood* / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D050177:Overweight; D036361:Peptide Hormones / Q000097:blood* / Q000378:metabolism; D011184:Postoperative Period
chemical_list: D005768:Gastrointestinal Hormones; D006442:Glycated Hemoglobin; D015850:Interleukin-6; D036361:Peptide Hormones; C508600:IL6 protein, human