Surgery for nonobese type 2 diabetic patients: an interventional study with duodenal-jejunal exclusion.
BACKGROUND
A 24-week interventional prospective trial was performed to compare the benefits of open duodenal-jejunal exclusion surgery (GJB) with a matched control group on standard medical care.


METHODS
One-hundred eighty patients were screened for the surgical approach. Twelve patients accepted to be operated and presented the full eligibility criteria for surgery that includes overweight BMI (25-29.9 kg/m2), T2DM diagnosis for less than 15 years, insulin-treated patients, no history of major complications, preserved beta-cell function, and absence of autoimmunity. A matched control group (CG) of patients whom refused surgical treatment was placed to receive standard care. Patients had age of 50 (5) years, time of diagnosis 9 years (range, 3 to 15 years), time of insulin usage 6 months (range, 3 to 48 months), fasting glucose (FG), 9.8 (2.5) mg/dL, and glycated hemoglobin (A1C) 8.90 (2.12)%.


RESULTS
At 24 weeks after surgery, patients experienced greater reductions on FG (14% vs. 7% on CG), A1C (from 8.78 to 7.84 in GJB-p<0.01 and 8.93 to 8.71 in CG; p<0.05 between groups) and reductions on average daily insulin requirement (93% vs. 29%, p<0.01). Ten patients stopped insulin usage in GJB but they remain taking oral medications. No differences were observed in both groups regarding BMI, body distribution and composition, blood pressure, and lipids.


CONCLUSIONS
In conclusion, duodenal-jejunal exclusion was an effective treatment for nonobese T2DM subjects. GJB was superior to standard care in achieving better glycemic control along with reduction in insulin requirements.
Geloneze
Bruno
B
LIMED, Laboratory of Investigation on Metabolism and Metabolism, State University of Campinas, UNICAMP, Rua Carlos Chagas 420, Campinas, SP, 13082-970, Brazil. bgeloneze@terra.com.br
Geloneze
Sylka R
SR
Fiori
Carla
C
Stabe
Christiane
C
Tambascia
Marcos A
MA
Chaim
Elinton A
EA
Astiarraga
Brenno D
BD
Pareja
Jose Carlos
JC
D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000601:surgery*; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin