title: Improvement of insulin resistance and reduction of cardiovascular risk among obese patients with type 2 diabetes with the duodenojejunal bypass liner.
abstract: BACKGROUND
  This study aims to evaluate the effectiveness of the duodenojejunal bypass liner (DJBL) in the improvement of insulin resistance and reduction of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus, using the triglyceride/high-density lipoprotein (HDL) cholesterol ratio, percentage of weight loss, and glycemic control.
  
  
  METHODS
  We used the TG/HDL ratio with a cutoff value of 3.5 to identify patients with insulin resistance. The value of the initial ratio was compared with the ratio obtained 6 months after implantation to evaluate whether an improvement in insulin resistance occurred. We also evaluated the improvement of glycated hemoglobin levels and the weight loss resulted from the use of the device and correlated that with the improvement of the TG/HDL ratio.
  
  
  RESULTS
  All patients implanted with the device presented a statistically significant reduction of the HbA1c levels, with most patients (70.3%) obtaining diabetes control with HbA1c levels lower than 7% at the end of the study. All patients also presented a significant weight reduction, with an average loss of 12.6% of their initial weight. We observed an important improvement in insulin resistance and metabolic syndrome, with a significant reduction of the TG/HDL ratio from 5.75 to 4.36 (p < 0.001) and 42.6% of the patients presenting a TG/HDL ratio lower than 3.5 at the end of the study.
  
  
  CONCLUSIONS
  The DJBL, when used for a period of 6 months, is effective in the control of diabetes, weight loss, improvement of insulin resistance, and decrease of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus.
authors: Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255-Cerqueira César, 05403-000, São Paulo, Brazil. eduardoghdemoura@gmail.com
authors: Eduardo Guimarães Hourneaux
authors: EG
authors: de Moura
authors: Ivan Roberto Bonotto
authors: IR
authors: Orso
authors: Bruno da Costa
authors: BC
authors: Martins
authors: Guilherme Sauniti
authors: GS
authors: Lopes
authors: Suzana Lopes
authors: SL
authors: de Oliveira
authors: Manoel dos Passos
authors: Mdos P
authors: Galvão-Neto
authors: Marcio Correa
authors: MC
authors: Mancini
authors: Marco Aurélio
authors: MA
authors: Santo
authors: Paulo
authors: P
authors: Sakai
authors: Almino Cardoso
authors: AC
authors: Ramos
authors: Arthur Belarmino
authors: AB
authors: Garrido-Júnior
authors: Alfredo
authors: A
authors: Halpern
authors: Ivan
authors: I
authors: Cecconello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000295:instrumentation*; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications*; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D019736:Prostheses and Implants; D012306:Risk; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human