title: Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21-29.
abstract: BACKGROUND
  The objective of this study is to evaluate the clinical results of the laparoscopic interposition of a segment of ileum into the proximal duodenum associated to a sleeve gastrectomy (II-DSG) in order to treat patients with type 2 diabetes mellitus (T2DM) and body mass index (BMI) 21-29 kg/m2.
  
  
  METHODS
  The laparoscopic procedure was performed in 69 patients, 22 female and 47 male. Mean age was 51 years (range 41-63 years). Mean BMI was 25.7 (21.8-29.2) kg/m2. All patients had the diagnosis of T2DM for at least 3 years and evidence of stable treatment with oral hypoglycemic agents and or insulin for at least 12 months. Insulin therapy was used by 44% of the patients. Mean duration of T2DM was 11 years (range 3-18 years). Dyslipidemia was diagnosed in 72.5% and hypertension in 66.7%. Nephropathy was characterized in 29% of the patients, retinopathy in 26.1%, and neuropathy in 24.6%.
  
  
  RESULTS
  Overall, 95.7% of the patients achieved adequate glycemic control (Hb(A1c) < 7%) without antidiabetic medication. Hb(A1c) below 6% was achieved by 65.2%. Mean postoperative follow-up was 21.7 months (range 7-42 months). Mean postoperative BMI was 21.8 kg/m2. There was no conversion to open surgery. Median hospital stay was 3.4 days (range 2-58 days). Major postoperative complications were diagnosed in 7.3%. There was no mortality. Fasting glycemia decreased from a mean of 218 to 102 mg/dl, postprandial glycemia from 305 to 141 mg/dl, and homeostasis model assessment of insulin resistance (Homa-IR) from 5.2 to 0.77. All associated comorbidities and complications related to T2DM had significant improvement or control. Arterial hypertension was controlled in 91.3%. Macroalbuminuria was no longer observed. Microalbuminuria resolved in 87.5% of patients. Hypercholesterolemia was normalized in 95% and hypertriglyceridemia in 92% of patients.
  
  
  CONCLUSIONS
  Laparoscopic II-DSG was an effective operation in controlling T2DM in a nonobese (BM < 30 kg/m2) population. Associated diseases and related complications were also improved. A longer follow-up period is needed.
authors.affiliation: , Av. 136, no. 961, 14 masculine andar, Setor Marista, 74.093-250, Goiania, Goias, Brazil, adepaula@uol.com.br
authors.forename: A L
authors.initials: AL
authors.lastname: DePaula
authors.forename: A L V
authors.initials: AL
authors.lastname: Macedo
authors.forename: B R
authors.initials: BR
authors.lastname: Mota
authors.forename: V
authors.initials: V
authors.lastname: Schraibman
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001786:Blood Glucose / Q000378:metabolism; 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*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose