title: Laparoscopic duodenal-jejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI<30 kg/m2 (LBMI).
abstract: BACKGROUND
  The association between medical and dietetic-behavioral treatments of type 2 diabetes mellitus (T2DM) has demonstrated to have variable results. The surgical treatment of T2DM is justifiable after the observation of a successful glycemic control in patients submitted to Roux-en-Y gastric bypass and biliopancreatic diversion. Experiments have shown an important role of the proximal intestine in glycemia decrease and diabetes control.
  
  
  METHODS
  Twenty diabetic patients underwent laparoscopic duodenal-jejunal exclusion. The variables studied were body mass index (BMI), fasting glycemia, glycosylated hemoglobin (HbA1c), and C-peptide, in the preoperative period and after 3 and 6 months.
  
  
  RESULTS
  There was a BMI decrease up to the third month and a weight stabilization between the third and sixth months. There was a significant reduction in fasting glycemia (43.8%) and HbA1c (22.8%) up to the sixth month (p<0.001). C-peptide did not show any significant alteration until the third month, although there was a considerable increase (25%) between the third and the sixth months (p<0.001). Only two patients were on oral medication after the sixth month.
  
  
  CONCLUSIONS
  Preliminary results have shown an important effect of the laparoscopic duodenal-jejunal exclusion in the treatment of T2DM. Studies with longer follow-up and a larger number of patients are necessary to better define the role of this new and promising procedure.
authors.affiliation: Gastrointestinal, Bariatric and Metabolic Surgery, Gastro Obeso Center, São Paulo, Brazil.
authors.forename: Almino C
authors.initials: AC
authors.lastname: Ramos
authors.forename: Manoel P
authors.initials: MP
authors.lastname: Galvão Neto
authors.forename: Yglésio Moyses
authors.initials: YM
authors.lastname: de Souza
authors.forename: Manoela
authors.initials: M
authors.lastname: Galvão
authors.forename: Abel H
authors.initials: AH
authors.lastname: Murakami
authors.forename: Andrey C
authors.initials: AC
authors.lastname: Silva
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Canseco
authors.forename: Raúl
authors.initials: R
authors.lastname: Santamaría
authors.forename: Trino A
authors.initials: TA
authors.lastname: Zambrano
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D004385:Duodenostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007581:Jejunoileal Bypass / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications* / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult