title: Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index.
abstract: BACKGROUND
  Bariatric surgery frequently results in the resolution of type 2 diabetes mellitus (T2DM). One of the many factors that could explain such findings is the duodenal exclusion of the alimentary tract. To test this hypothesis, a surgical model that induces glycemic control without significant weight loss would be ideal. In the present study, we evaluated the early metabolic changes that occur in overweight diabetic patients after laparoscopic duodenal-jejunal bypass (DJB) and determined the factors associated with success in T2DM resolution. The setting was a private practice.
  
  
  METHODS
  A total of 35 patients (20 men and 15 women) were included in the present study. The mean preoperative body mass index was 28.4 ± 2.9 kg/m(2). DJB was performed in all patients, and the anthropometric data and blood samples were collected at baseline (preoperatively) and 3, 6, 9, and 12 months after surgery. Success was defined when patients reached a glycated hemoglobin level of <7% without diabetic medication.
  
  
  RESULTS
  T2DM remission was observed in 14 (40%) of 35 patients. No differences in the homeostasis model assessment insulin resistance index levels and patient weight were observed before and 12 months after DJB surgery. Gender, duration of T2DM, previous use of insulin, preoperative homeostasis model assessment insulin resistance index, and C-peptide levels were not significant predictive factors of success or nonsuccess. The only factor that significantly predicted postoperative positive outcomes was a waist circumference reduction of ≥ 7% compared with baseline within the first 6 months after surgery.
  
  
  CONCLUSIONS
  DJB improves glycemic control; however, it does not increase insulin sensitivity in overweight diabetic patients. These changes were observed without significant weight loss.
authors.affiliation: Department of Surgery, Center for Surgical Treatment of Morbid and Metabolic Disorders, Hospital Alemão Oswaldo Cruz, São Paulo, São Paulo, Brazil. ricardo.cohen@haoc.com.br
authors.forename: Ricardo
authors.initials: R
authors.lastname: Cohen
authors.forename: Pedro Paulo
authors.initials: PP
authors.lastname: Caravatto
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Correa
authors.forename: Patricia
authors.initials: P
authors.lastname: Noujaim
authors.forename: Tarissa Zanata
authors.initials: TZ
authors.lastname: Petry
authors.forename: João Eduardo
authors.initials: JE
authors.lastname: Salles
authors.forename: Carlos Aurelio
authors.initials: CA
authors.lastname: Schiavon
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D001835:Body Weight; D002096:C-Peptide / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods; D055105:Waist Circumference
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents