title: Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35.
abstract: OBJECTIVE
  Biliopancreatic diversion (BPD) resolves type 2 diabetes in near totality of morbidly obeses [BMI (body mass index) ≥35 kg/m]. However, studies of BPD effect in BMI range 25.0 to 34.9 kg/m, including about 90% of diabetic patients, are lacking.
  
  
  METHODS
  If BPD effects are independent of weight changes, they should be maintained in patients who, being mildly obese or overweight, will lose little or no weight after operation. Thirty type 2 diabetic patients with BMI 25 to 34.9 were submitted to BPD and monitored 12 months. Thirty-eight diabetic patients selected from a large database, kept 1 year on medical therapy, served as controls.
  
  
  RESULTS
  Nineteen male and 11 female. Mean age 56.4 ± 7.4 years, weight 84.8 ± 11.1 kg, BMI 30.6 ± 2.9 kg/m, waist circumference 104 ± 9.4 cm, diabetes duration 11.2 ± 6.9 years, HbA1c 9.3±1.5. Twelve patients on insulin. Fifteen (2 F) with BMI < 30 (mean: 28.1). No mortality or major adverse events occurred. BMI progressively decreased, stabilizing around 25 since the fourth month, without excessive weight loss. One year after BPD, mean HbA1c was 6.3%±0.8, with 25 patients (83%) controlled (HbA1c≤7%) on free diet, without antidiabetics, and the remaining improved. Acute insulin response to intravenous glucose had increased from 1.2 ± 2.9 to 4.2 ± 4.4 μIU/mL. Diabetes resolution correlated positively with BMI. HbA1c decreased at 1 year in the control group, along with an overall increased amount of antidiabetic therapy.
  
  
  CONCLUSIONS
  BPD improves or resolves diabetes in BMI 25 to 35 without causing excessive weight loss, its action being on insulin sensitivity and beta-cell function. The strikingly different response between morbidly obese and low BMI patients might depend on different beta-cell defect. ClinicalTrials.gov Identifier: NCT00996294.
authors.affiliation: Department of Surgery, University of Genoa, Italy. nicola.scopinaro@unige.it
authors.forename: Nicola
authors.initials: N
authors.lastname: Scopinaro
authors.forename: Giovanni F
authors.initials: GF
authors.lastname: Adami
authors.forename: Francesco S
authors.initials: FS
authors.lastname: Papadia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Camerini
authors.forename: Flavia
authors.initials: F
authors.lastname: Carlini
authors.forename: Martin
authors.initials: M
authors.lastname: Fried
authors.forename: Lucia
authors.initials: L
authors.lastname: Briatore
authors.forename: Gabriele
authors.initials: G
authors.lastname: D'Alessandro
authors.forename: Gabriella
authors.initials: G
authors.lastname: Andraghetti
authors.forename: Renzo
authors.initials: R
authors.lastname: Cordera
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents