title: Effects of bilio-pancreatic diversion on diabetic complications: a 10-year follow-up.
abstract: OBJECTIVE
  The surgical option could represent a valid alternative to medical therapy in some diabetic patients. However, no data are available on long-term effects of metabolic surgery on diabetic complications. We aimed to determine whether patients with newly diagnosed type 2 diabetes who underwent bilio-pancreatic diversion (BPD) had less micro- and macrovascular complications than those who received conventional therapy.
  
  
  METHODS
  This was an unblinded, case-controlled trial with 10-years' follow-up, conducted from July 1998 through October 2009 at the Day Hospital of Metabolic Diseases, Catholic University, Rome, Italy. A consecutive sample of 110 obese patients (BMI >35 kg/m(2)) with newly diagnosed type 2 diabetes was enrolled. The study was completed by 50 subjects. The main outcome measure was long-term effects (10 years) of BPD versus those associated with conventional therapy on microvascular outcome, micro- and macroalbuminuria, and glomerular filtration rate (GFR). Secondary measures included macrovascular outcomes, type 2 diabetes remission, glycated hemoglobin, and hyperlipidemia.
  
  
  RESULTS
  Ten-year GFR variation was -45.7 ± 18.8% in the medical arm and 13.6 ± 24.5% in the surgical arm (P < 0.001). Ten-year hypercreatininemia prevalence was 39.3% in control subjects and 9% in BPD subjects (P = 0.001). After 10 years, all BPD subjects recovered from microalbuminuria, whereas microalbuminuria appeared or progressed to macroalbuminuria in control subjects. Three myocardial infarctions, determined by electrocardiogram, and one stroke occurred in control subjects. After the 10-year follow-up, coronary heart disease (CHD) probability was 0.22 ± 0.10 and 0.05 ± 0.04 in the medical and surgical groups, respectively (P < 0.001). Remission from type 2 diabetes was observed in all patients within 1 year of surgery. Surgical and medical subjects had lost 34.60 ± 10.25 and 0.38 ± 6.10% of initial weight at the 10-year follow-up (P < 0.001).
  
  
  CONCLUSIONS
  Renal and cardiovascular complications were dramatically reduced in the surgical arm, indicating long-term benefits of BPD on diabetic complications, at least in the case of morbid obesity with decompensated type 2 diabetes.
authors.affiliation: Department of Internal Medicine, Catholic University, Rome, Italy.
authors.forename: Amerigo
authors.initials: A
authors.lastname: Iaconelli
authors.forename: Simona
authors.initials: S
authors.lastname: Panunzi
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gaetano
authors.forename: Melania
authors.initials: M
authors.lastname: Manco
authors.forename: Caterina
authors.initials: C
authors.lastname: Guidone
authors.forename: Laura
authors.initials: L
authors.lastname: Leccesi
authors.forename: Donatella
authors.initials: D
authors.lastname: Gniuli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nanni
authors.forename: Marco
authors.initials: M
authors.lastname: Castagneto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ghirlanda
authors.forename: Geltrude
authors.initials: G
authors.lastname: Mingrone
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000097:blood; D015904:Biliopancreatic Diversion; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D003404:Creatinine